BACKGROUND AND OBJECTIVE Atrial Fibrillation (AF) is associated with an increased risk of stroke and development of cognitive impairment. Our cross-sectional study aims to identify risk factors for cognitive impairment in patients with permanent AF. MATERIALS AND METHODS 212 consecutive outpatients with history of permanent AF lasting more than 1 year were enrolled and the Short Portable Mental Status Questionnaire (SPMSQ) was used to assess cognitive impairment (number of errors ≥5). The type of antithrombotic therapy, the time in therapeutic range (TTR) in case of treatment with warfarin and the degree of heart rate (HR) control (upon Holter ECG monitoring) were also assessed. RESULTS ROC curve analysis indicated that TTR was associated with cognitive impairment (AUC 0.85 ± 0.03; 95% CI 0.77-0.88; p < 0.0001). Multivariate logistic regression analysis showed an independent association of previous cerebrovascular or cardiovascular events (OR 7.24, 95% CI 1.37-38.25; p = 0.020), aspirin therapy instead of anticoagulant therapy (OR 24.74, 95% CI 1.27-482.12; p = 0.034), warfarin use with TTR ≤60% (OR 21.71 , 95%CI 4.35-108; p < 0.001) and an average daily HR either <60 bpm or >100 bpm (OR 6.04, 95% 1.09-33.29; p = 0.039) with cognitive impairment. CONCLUSION Among patients with permanent AF, cognitive impairment is more frequent in those with inadequate antithrombotic therapy (aspirin therapy instead of anticoagulant therapy) and with suboptimal oral anticoagulation (TTR ≤60%) or heart rate control. Efforts should be made to optimize therapies related to these parameters.

中文翻译：

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永久性心房颤动患者认知障碍的独立危险因素分析：一项横断面观察研究。

背景和目的心房颤动（AF）与中风和认知障碍发展的风险增加有关。我们的横断面研究旨在确定永久性AF患者认知障碍的危险因素。材料与方法招募了212名连续1年以上的永久性房颤病史的门诊患者，并使用了简短便携式心理状态问卷（SPMSQ）评估认知障碍（错误数≥5）。还评估了抗血栓治疗的类型，使用华法林治疗时的治疗时间（TTR）和心率（HR）控制程度（在Holter ECG监测下）。结果ROC曲线分析表明TTR与认知障碍有关（AUC 0.85±0.03; 95％CI 0.77-0.88; p <0.0001）。多元logistic回归分析显示先前脑血管或心血管事件的独立关联（OR 7.24，95％CI 1.37-38.25; p = 0.020），阿司匹林治疗代替抗凝治疗（OR 24.74，95％CI 1.27-482.12; p = 0.034 ），华法令的TTR≤60％（OR 21.71，95％CI 4.35-108; p <0.001），平均每日HR≤60 bpm或> 100 bpm（OR 6.04，95％1.09-33.29; p = 0.039 ）有认知障碍。结论在永久性房颤患者中，抗血栓治疗不充分（阿司匹林代替抗凝治疗），口服抗凝不理想（TTR≤60％）或心率控制不佳的患者认知障碍更为常见。应该努力优化与这些参数有关的疗法。