The European Heart Rhythm Association (EHRA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS) have issued a first expert consensus statement on cognitive function and arrhythmias. According to which, the patients with atrial fibrillation (AF) could decrease their dementia risk by taking oral anticoagulation therapy.
The guidelines were published in the journals Heart Rhythm and Europace.
Nikolaos Dagres, Heart Centre Leipzig, Germany, and colleagues drafted the guidelines with an objective to raise awareness of cognitive function among physicians treating patients with arrhythmias and to provide them with practical proposals that may lead to improvement of patient care in this regard.
Interventions to be considered for prevention of cognitive dysfunction in atrial fibrillation patients:
- In relation to AF management, oral anticoagulation (early identification of appropriate candidates, improving drug adherence, avoiding warfarin in those with poor TTR (time in therapeutic range), and optimal TTR management); rhythm control; antihypertensive treatment; treatment of concomitant heart failure.
- Non-specific pharmacologic interventions: glycemic control, hormone replacement therapy, avoid aspirin therapy unless specific clinical indication present.
- Alzheimer’s disease-specific pharmacologic interventions.
Multifactorial vascular risk factor management
- Target blood pressure, cholesterol, diabetes, sleep apnoea, obesity via diet, medication, smoking cessation, and physical activity.
- Low levels of vitamin D and B12, and folate increase risk, but the value of supplementation remains unproven.
- Calcium supplementation in women has been associated with increased dementia risk. The value of modulating cognitive function based on educational interventions is uncertain.
- Weight loss in obesity.
Some other interventions include cognitive activities or training, physical exercise, and multi-domain interventions.
Recommendations for measures to prevent cognitive dysfunction in AF patients:
- Appropriate anticoagulation in patients with AF and stroke risk factors should be applied for the prevention of cognitive dysfunction.
- Consider non-vitamin K antagonist oral anticoagulant (NOAC) instead of vitamin K antagonist (VKA) when using oral anticoagulation for the prevention of stroke in AF, which may have a beneficial effect on subsequent cognitive disorders.
- In patients with AF managed with long-term VKA, a high anticoagulation time in therapeutic range may be beneficial for optimal prevention of new-onset dementia.
- General health measures (prevention of smoking, hypertension, obesity and diabetes, sleep apnoea, and appropriate control of all risk factors) may reduce the concomitant risks of AF (new onset or recurrences) and stroke, with a putative benefit on cognitive function.
- Prevention of cognitive dysfunction in AF may include general measures proposed in vascular dementia or Alzheimer’s disease.
- Cognitive assessment should be performed in AF patients where there is suspicion of cognitive impairment.