Associations of subclinical heart failure and atrial fibrillation with mild cognitive impairment: a cross-sectional study in a subclinical heart failure screening programme.

Elizabeth L Potter; Satish Ramkumar; Leah Wright; Thomas H Marwick
Abstract
Effective identification and management of subclinical left ventricular (LV) dysfunction (LVD) and subclinical atrial fibrillation (AF) by screening elderly populations might be compromised by mild cognitive impairment (MCI). We sought to characterise the prevalence and profile of MCI and evaluate associations with LV and left atrial (LA) dysfunction and AF, in a trial of screening for subclinical LVD and AF.Cross-sectional.Australian, community-based intervention trial.Adults aged ≥65 years with ≥1 LVD risk factors without ischaemic heart disease (n=337).The Montreal cognitive assessment (MoCA) was obtained. Subclinical LVD was defined as echocardiographic global longitudinal strain ≤16%, diastolic dysfunction or LV hypertrophy; abnormal LA reservoir strain (LARS) was defined as <24%. Subclinical AF was detected using a single-lead portable electrocardiographic device in those without pre-existing AF who gave consent (n=293).Subclinical LVD was found in 155 (46%), abnormal LARS in 9 (3.6%) and subclinical AF in 11 (3.8%). MoCA score consistent with MCI (<26) was found in 101 (30%); executive function (69%) and delayed recall (93%), were the most frequently abnormal domains. Compared with normal cognition, MCI was associated with non-adherence to AF screening (25% vs 40%, p=0.01). In multivariable logistic regression modelling, educational achievement, systolic blood pressure, body mass index and waist-to-hip ratio were independently associated with MCI. However, neither subclinical AF nor any measure of cardiac dysfunction, were associated with MCI.The 30% prevalence of MCI among elderly subjects with risk factors for subclinical LVD and AF has important implications for screening strategies and management. However, MCI is not associated with subclinical myocardial dysfunction nor subclinical AF.Australian New Zealand Clinical Trials Registry (ACTRN12617000116325).
Journal BMJ OPEN
ISSN 2044-6055
Published 05 Jul 2021
Volume 11
Issue 7
Pages e045896
DOI 10.1136/bmjopen-2020-045896
Type Journal Article | Randomized Controlled Trial | Research Support, Non-U.S. Gov't
Sponsorship