Atrial Fibrillation: Possible Influences of Rate and Rhythm Control Strategy on Cognitive Performance

OBJECTIVES: To determine whether rate or rhythm control strategy may affect cognition in older adults with atrial fibrillation (AF).DESIGN: Retrospective analysis of the REgistro POliterapie SIMI database.SETTING: Italian internal medicine and geriatric wards.PARTICIPANTS: Individuals aged 65 and older (N=1,082, mean age 80.6 ± 7; 50% male) with AF before hospital admission (for any cause).MEASUREMENTS: Evaluation of cognitive performance using the Short Blessed Test (SBT) according to rhythm and rate control strategy, anticoagulant and antiplatelet therapy, age, education, and comorbidities.RESULTS: Two hundred seventy-two participants (25%) received rhythm control therapy, 331 (30.6%) rate control therapy, and 479 (44.3%) no therapy of interest. Four hundred thirty-six (40.3%) in the total sample and in the different rhythm and rate control strategy groups were treated with an oral anticoagulant. Cognitive performance (mean SBT score) was found to be higher in the rhythm control group (7.5 ± 6.6) than in the no therapy (9.9 ± 7.9) and rate control (10.6 ± 8.3) (p<.001) groups. Logistic regression models adjusted for age, sex, education, anticoagulant and antiplatelet therapy, and comorbidities found that the rhythm control strategy (adjusted odds ratio (aOR)=0.56, 95% confidence interval (CI)=0.40-0.79, p=.001) and education (aOR 0.50, 95% CI=0.35-0.62; p<.001) were associated with less likelihood of cognitive impairment CONCLUSION: In the absence of anticoagulation, rhythm control of AF may protect against cognitive decline.