title: Atrial fibrillation, cognitive impairment, frailty and disability in older heart failure patients.
abstract: BACKGROUND
  Aim of the study was to prospectively assess the relation between atrial fibrillation, cognitive impairment, frailty and disability in older patients with chronic heart failure .
  
  
  METHODS
  Three hundred thirty-one ambulatory community-living patients aged 70 years and older (mean 78 ± 6; range 70-93; 43% women) in stable conditions and optimized therapy were enrolled in seven heart failure cardiology clinics. Cognitive impairment was defined by a corrected Mini Mental State Examination score less than 24. Gait speed was used as marker of frailty and measured on a 4 m distance at usual pace.
  
  
  RESULTS
  Ninety-eight patients (30%) were on atrial fibrillation at enrolment and 20 (6%) had a history of paroxysmal/persistent atrial fibrillation. Patients with atrial fibrillation were more frequently women with severe valvular disease, preserved left ventricular ejection fraction and less frequently on beta-blockers. At multivariable analyses, atrial fibrillation emerged as independently related to cognitive impairment [odds ratio (OR) 1.909 (1.072-3.397); P = 0.028], as well as to reduced gait speed [OR 4.366 (2.104-9.060); P < 0.001]. Furthermore, atrial fibrillation was significantly associated with disability in either basic or instrumental activities of daily living. No differences were found in mortality and morbidity.
  
  
  CONCLUSIONS
  Among patients with chronic heart failure, those with atrial fibrillation present a high prevalence of frailty, cognitive impairment and disability. The hypothetical mechanisms by which atrial fibrillation and heart failure may affect these conditions are multiple and further studies are warranted. However, screening for these variables in clinical practice is simple and inexpensive and may allow better strategies for intervention in this high-risk population.
authors.affiliation: aHeart Failure Clinic, Cardiology 1/CCU, San Camillo Hospital bCardiology Unit, Nuovo Regina Margherita Hospital, Rome cCardiovascular Center and University, Trieste dHeart Failure Unit, S. Maria della Misericordia Hospital, Perugia eCardiology Unit, S. Giovanni XXIII Hospital, Bergamo fHeart Failure Clinic, San Martino Hospital, Belluno gDivision of Cardiology, Villa Bianca Hospital, Trento hClinical Psychology Unit, San Camillo Hospital, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.forename: Donatella
authors.initials: D
authors.lastname: Del Sindaco
authors.forename: Maria D
authors.initials: MD
authors.lastname: Tinti
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Alunni
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.forename: Giovanni
authors.initials: G
authors.lastname: Minardi
authors.forename: Adriano
authors.initials: A
authors.lastname: Murrone
authors.forename: Paola
authors.initials: P
authors.lastname: Ciurluini
authors.forename: Massimo
authors.initials: M
authors.lastname: Uguccioni
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology*; D002908:Chronic Disease; D060825:Cognitive Dysfunction / Q000453:epidemiology*; D005260:Female; D016330:Frail Elderly; D005684:Gait; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D016277:Ventricular Function, Left