Abstract
Objectives
To evaluate the clinical characteristics and the long-term outcome of atrial fibrillation
(AF) patients with dementia and history of syncope or falls.
Design
Observational: analysis of a prospective registry.
Setting and Participants
Between 2012 and 2016, the Syncope and Dementia Registry enrolled patients in 12 geriatric
departments. Follow-up evaluation was at 12 months.
Measures
Clinical, functional, and cognitive assessment.
Results
Of the 522 patients (women, 62.1%; Mini-Mental State Examination 17 ± 6), 26.4% have
or presented an AF history. Patients with AF were older (85 ± 6 vs 83 ± 6 years, P = .012), with higher heart rate (78 ± 17 vs. 73 ± 14 bpm, P < .001), prescribed drugs (6.9 ± 2.9 vs 5.9 ± 2.7, P < .001), and an increased number (3.9 ± 2.0 vs 3.0 ± 1.8, P < .001) and severity of comorbidities. Oral anticoagulant therapy was underprescribed
(39.9%). Cardiac syncope was more frequently diagnosed (18.8 vs 4.9%, P < .001). At multivariate analysis, AF patients were characterized by advanced age,
a higher severity of comorbidities, a greater number of prescribed drugs, an increased
heart rate, and a more frequent presence of cardiac symptoms. One-year mortality differed
little between patients with and without AF (27.7 vs 22.1%, P = .229). In the arrhythmia group, multivariate predictors of prognosis were disability
(number of lost BADLs; P = .020) and a higher heart rate (P = .006).
Conclusions and Implications
AF and postural stability-related issues often co-exist in persons with dementia.
This complex of conditions is associated with an intricate clinical picture, underprescription
of oral anticoagulants, and high long-term mortality. Future studies are needed to
evaluate the effects of therapy optimization in this population.
Keywords
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Article info
Publication history
Published online: March 13, 2020
Footnotes
A.C. and S.F. both served as first author of the manuscript.
This research received funding from the Fondazione Cassa di Risparmio di Pistoia e Pescia. The sponsor had no role in the design of the study, in its methods, in patient recruitment, in data collection and their analysis, and in the preparation of this article.
The authors declare no conflicts of interest.
Identification
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
