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Atrial Fibrillation in Older Patients with Syncope and Dementia: Insights from the Syncope and Dementia Registry
Journal of the American Medical Directors Association ( IF 4.2 ) Pub Date : 2020-09-01 , DOI: 10.1016/j.jamda.2020.01.110
Alice Ceccofiglio 1 , Stefano Fumagalli 1 , Chiara Mussi 2 , Enrico Mossello 1 , Mario Bo 3 , Anna Maria Martone 4 , Giuseppe Bellelli 5 , Franco Nicosia 6 , Daniela Riccio 7 , Assunta Langellotto 8 , Gianni Tava 9 , Virginia Boccardi 10 , Elisabetta Tonon 11 , Pasquale Abete 12 , Andrea Ungar 1
Affiliation  

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.

中文翻译:

老年晕厥和痴呆患者的心房颤动:来自晕厥和痴呆登记处的见解

目的 评估心房颤动 (AF) 痴呆和晕厥或跌倒史患者的临床特征和长期预后。设计观察:前瞻性登记分析。设置和参与者 2012 年至 2016 年期间,晕厥和痴呆登记处招募了 12 个老年科的患者。随访评估为 12 个月。措施 临床、功能和认知评估。结果 522 名患者(女性,62.1%;简易精神状态检查 17 ± 6)中,26.4% 有或有 AF 病史。房颤患者年龄较大(85 ± 6 vs 83 ± 6 岁,P = .012),心率更高(78 ± 17 vs. 73 ± 14 bpm,P < .001),处方药物(6.9 ± 2.9 vs 5.9 ± 2.7, P < .001),并且合并症的数量和严重程度增加(3.9 ± 2.0 vs 3.0 ± 1.8, P < .001)。口服抗凝治疗处方不足(39.9%)。心脏性晕厥的诊断率更高(18.8% vs 4.9%,P < .001)。在多变量分析中,房颤患者的特征是高龄、合并症的严重程度更高、处方药数量更多、心率加快和心脏症状出现频率更高。有和无 AF 患者的一年死亡率差异很小(27.7% vs 22.1%,P = .229)。在心律失常组中,预后的多变量预测因子是残疾(丢失 BADL 的数量;P = .020)和较高的心率(P = .006)。结论和意义 AF 和姿势稳定性相关问题通常在痴呆症患者中并存。这种复杂的情况与复杂的临床表现、口服抗凝剂处方不足和长期高死亡率有关。
更新日期:2020-09-01
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