Brain and kidney, victims of atrial microembolism in elderly hospitalized patients? Data from the REPOSI study.
BACKGROUND
It is well known that atrial fibrillation (AF) and chronic kidney disease (CKD) are associated with a higher risk of stroke, and new evidence links AF to cognitive impairment, independently from an overt stroke (CI). Our aim was to investigate, assuming an underlying role of atrial microembolism, the impact of CI and CKD in elderly hospitalized patients with AF.


METHODS
We retrospectively analyzed the data collected on elderly patients in 66 Italian hospitals, in the frame of the REPOSI project. We analyzed the clinical characteristics of patients with AF and different degrees of CI. Multivariate logistic analysis was used to explore the relationship between variables and mortality.


RESULTS
Among the 1384 patients enrolled, 321 had AF. Patients with AF were older, had worse CI and disability and higher rates of stroke, hypertension, heart failure, and CKD, and less than 50% were on anticoagulant therapy. Among patients with AF, those with worse CI and those with lower estimated glomerular filtration rate (eGFR) had a higher mortality risk (odds ratio 1.13, p=0.006). Higher disability levels, older age, higher systolic blood pressure, and higher eGFR were related to lower probability of oral anticoagulant prescription. Lower mortality rates were found in patients on oral anticoagulant therapy.


CONCLUSIONS
Elderly hospitalized patients with AF are more likely affected by CI and CKD, two conditions that expose them to a higher mortality risk. Oral anticoagulant therapy, still underused and not optimally enforced, may afford protection from thromboembolic episodes that probably concur to the high mortality.
Biomedical Department of Internal Medicine and Subspecialities (DiBiMIS), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy; Department of Internal Medicine 2, National Relevance and High Specialization Hospital Trust, ARNAS Civico, Di Cristina Benfratelli, Palermo, Italy. Electronic address: s.corrao@tiscali.it.
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Corrao
Biomedical Department of Internal Medicine and Subspecialities (DiBiMIS), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy.
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Argano
Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy.
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Nobili
Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy; Department of Internal Medicine, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milano, Italy.
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Marcucci
Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy; Scientific Direction, IRCCS Ca Granda Maggiore Policlinico Hospital Foundation, Via Pace 9, 20122 Milan, Italy.
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Djade
Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy.
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Tettamanti
Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy.
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Pasina
Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy.
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Franchi
Department of Clinical and Experimental Science, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
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Marengoni
Internal Medicine, IRCCS Policlinico San Donato, Department of Medical and Surgery, Sciences, University of Milano, Via Morandi 30, 20097 San Donato, Milan, Italy.
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Salerno
Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161 Roma, Italy.
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Violi
Scientific Direction, IRCCS Ca Granda Maggiore Policlinico Hospital Foundation, Via Pace 9, 20122 Milan, Italy.
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Mannucci
Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Campus Universitario di Germaneto, Viale Europa, 88100 Catanzaro, Italy.
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Perticone
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality*; D001921:Brain / Q000503:physiopathology; D003072:Cognition Disorders / Q000188:drug therapy; D003704:Dementia / Q000188:drug therapy; D004185:Disability Evaluation; D005260:Female; D005919:Glomerular Filtration Rate; D006325:Heart Atria; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control; D013923:Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants
Aged; Anticoagulants; Atrial fibrillation; Dementia; Renal insufficiency, chronic; Stroke