Incident frailty and cognitive impairment by heart failure status in older patients with atrial fibrillation: the SAGE-AF study
Wei-Jia WANG1
Darleen Lessard2
Jane Saczynski3
Robert J Goldberg2
Alan S. Go4
Tenes Paul1
Ely Gracia1
David D McManus5
1.Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA2.Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA3.Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA, USA4.Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA5.Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA;Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
摘要：Background Atrial fibrillation (AF) and heart failure (HF) frequently co-occur in older individuals. Among patients with AF, HF in?creases risks for stroke and death, but the associations between HF and incident cognition and physical impairment remain unknown. We aimed to examine the cross-sectional and prospective associations between HF, cognition, and frailty among older patients with AF. Methods The SAGE-AF (Systematic Assessment of Geriatric Elements in AF) study enrolled 1244 patients with AF (mean age 76 years, 48％ women) from five practices in Massachusetts and Georgia. HF at baseline was identified from electronic health records using ICD-9/10 codes. At baseline and 1-year, frailty was assessed by Cardiovascular Health Survey score and cognition was assessed by die Montreal Cognitive Assessment Results Patients with prevalent HF (n = 463, 37.2％) were older, less likely to be non-Hispanic white, had less education, and had greater cardiovascular comorbidity burden and higher CHA2DS2VASC and HAS-BLED scores than patients without HF (all P's ＜ 0.01). In multivariable adjusted re?gression models, HF (present vs. absent) was associated with both prevalent frailty (adjusted odds ratio [aOR]: 2.38,95％ confidence interval [CI]:1.64-3.46) and incident frailty at 1 year (aOR: 2.48,95％ CI: 1.37-4.51). HF was also independently associated with baseline cognitive impair?ment (aOR: 1.60, 95％ CI: 1.22-2.11), but not with developing cognitive impairment at 1 year (aOR 1.04, 95％CI: 0.64-1.70). Conclusions Among ambulatory older patients with AF, the co-existence of HF identifies individuals with physical and cognitive impairments who are at higher short-term risk for becoming frail. Preventive strategies to this vulnerable subgroup merit consideration.
机标关键词：
论文发表日期：2020-11-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：6( 653-658 )
英文信息