Mild cognitive impairment impacts health outcomes of patients with atrial fibrillation undergoing a disease management intervention
Ball, Jocasta, Løchen, Maja-Lisa, Carrington, Melinda J., Wiley, Joshua and Stewart, Simon. (2018). Mild cognitive impairment impacts health outcomes of patients with atrial fibrillation undergoing a disease management intervention. Open Heart (online). 5(1), p. Article e000755. https://doi.org/10.1136/openhrt-2017-000755
|Authors||Ball, Jocasta, Løchen, Maja-Lisa, Carrington, Melinda J., Wiley, Joshua and Stewart, Simon|
Objective Mild cognitive impairment (MCI) is prevalent in atrial fibrillation (AF) and has the potential to contribute to poor outcomes. We investigated the influence of MCI on survival and rehospitalisation in patients with chronic forms of AF undergoing a home-based, AF-specific disease management intervention (home-based intervention (HBI)) or standard management (SM).
Methods The Montreal Cognitive Assessment tool was administered at baseline (a score of <26/30 indicated MCI) in patients with AF randomised to HBI versus SM. Post hoc analyses of mortality and rehospitalisations during a minimum 24-month follow-up were conducted in the overall cohort and in each study group separately.
Results Of 260 patients (mean age 72±11, 47% female), 65% demonstrated MCI on screening (34% in SM; 31% in HBI). Overall, the number of days spent alive and out-of-hospital during follow-up (P=0.012) and all-cause rehospitalisation were influenced by MCI during follow-up (OR 3.16 (95% CI 1.46 to 6.84)) but MCI did not influence any outcomes in the SM group. However, survival was negatively influenced by MCI in the HBI group (P=0.036); those with MCI in this group were 5.6 times more likely to die during follow-up (OR 5.57 (95% CI 1.10 to 28.1)). Those with MCI in the HBI group also spent less days alive and out-of-hospital than those with no MCI (P=0.022). MCI was also identified as a significant independent correlate of shortest duration of event-free survival (OR 3.48 (95% CI 1.06 to 11.4)), all-cause rehospitalisation (OR 3.30 (95% CI 1.25 to 8.69)) and cardiovascular disease (CVD)-related rehospitalisation (OR 2.35 (95% CI 1.12 to 4.91)) in this group.
Conclusions The effectiveness of home-based, disease management for patients with chronic forms of AF is negatively affected by comorbid MCI. The benefit of adjunctive support for patients with MCI on CVD-related health outcomes requires further investigation.
|Keywords||adult; aged; atrial fibrillation; cardiovascular disease; chronic disease; clinical effectiveness; clinical outcome; cohort analysis; comorbidity; controlled study; correlation analysis; disease management; event free survival; female; follow up; home care; hospital readmission; human; major clinical study; male; mild cognitive impairment; Montreal cognitive assessment; mortality; post hoc analysis; priority journal; randomized controlled trial; screening; smoking; survival; very elderly|
|Journal||Open Heart (online)|
|Journal citation||5 (1), p. Article e000755|
|Publisher||BMJ Publishing Group|
|Digital Object Identifier (DOI)||https://doi.org/10.1136/openhrt-2017-000755|
|PubMed Central ID||PMC5845397|
|Open access||Published as ‘gold’ (paid) open access|
|Funder||National Health and Medical Research Council (NHMRC)|
|National Heart Foundation of Australia|
|Operational Infrastructure Support (OIS) Program, Victorian Government|
|Research Group||Mary MacKillop Institute for Health Research|
File Access Level
|Online||07 Feb 2018|
|Publication process dates|
|Accepted||29 Dec 2017|
|License: CC BY-NC 4.0|
|File access level: Open|
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