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Incident frailty and cognitive impairment by heart failure status in older patients with atrial fibrillation: the SAGE-AF study

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Journal of Geriatric Cardiology 2020年第11期17卷 653-658页

作者： Wei-Jia WANG Darleen Lessard jane saczynski Robert J Goldberg Alan S.Go Tenes Paul Ely Gracia David D McManus Department of Medicine University of Massachusetts Medical SchoolWorcesterMAUSA Department of Population and Quantitative Health Sciences University of Massachusetts Medical SchoolWorcesterMAUSA Department of Pharmacy and Health System Sciences Northeastern UniversityBostonMAUSA Division of Research Kaiser Permanente Northern CaliforniaOaklandCAUSA

Background Atrial fibrillation(AF) and heart failure(HF) frequently co-occur in older individuals. Among patients with AF, HF increases risks for stroke and death, but the associations between HF and incident cognition and physical impairment remain unknown. We aimed to examine the cross-sectional and prospective associations between HF, cognition, and frailty among older patients with AF. Methods The SAGE-AF(Systematic Assessment of Geriatric Elements in AF) study enrolled 1244 patients with AF(mean age 76 years, 48% women) from five practices in Massachusetts and Georgia. HF at baseline was identified from electronic health records using ICD-9/10 codes. At baseline and 1-year, frailty was assessed by Cardiovascular Health Survey score and cognition was assessed by the Montreal Cognitive Assessment. Results Patients with prevalent HF(n = 463, 37.2%) were older, less likely to be non-Hispanic white, had less education, and had greater cardiovascular comorbidity burden and higher CHA2 DS2 VASC and HAS-BLED scores than patients without HF(all P's < 0.01). In multivariable adjusted regression models, HF(present vs. absent) was associated with both prevalent frailty(adjusted odds ratio [a OR]: 2.38, 95% confidence interval [CI]: 1.64-3.46) and incident frailty at 1 year(a OR: 2.48, 95% CI: 1.37-4.51). HF was also independently associated with baseline cognitive impairment(a OR: 1.60, 95% CI: 1.22-2.11), but not with developing cognitive impairment at 1 year(a OR 1.04, 95%CI: 0.64-1.70). Conclusions Among ambulatory older patients with AF, the co-existence of HF identifies individuals with physical and cognitive impairments who are at higher short-term risk for becoming frail. Preventive strategies to this vulnerable subgroup merit consideration.

关键词： Atrial fibrillation Cognitive impairment Heart failure Frailty

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维普期刊数据库

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Hearing loss and cognitive decline among older adults with atrial fibrillation:the SAGE-AF study

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Journal of Geriatric Cardiology 2020年第4期17卷 177-183页

作者： Wei-Jia WANG Darleen Lessard Hawa Abu David D.McManus Tanya Mailhot Jerry H.Gurwitz Robert J.Goldberg jane saczynski Division of Cardiovascular Medicine Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterMAUSA Department of Population and Quantitative Health Sciences University of Massachusetts Medical SchoolWorcesterMAUSA Department of Pharmacy and Health System Sciences Northeastern UniversityBostonMAUSA Meyers Primary Care Institute University of Massachusetts Medical SchoolWorcesterMAUSA

Objective To examine the association between hearing loss and cognitive function cross-sectionally and prospectively among older adults with atrial fibrillation(AF).Methods Patients with AF≥65-year-old(n=1244)in the SAGE(Systematic Assessment of Geriatric Elements)-AF study were recruited from five internal medicine or cardiology clinics in Massachusetts and *** was assessed by a structured questionnaire at *** function was assessed by Montreal Cognitive Assessment(MoCA)at baseline and one *** impairment was defined as score≤23 on the *** associations between hearing loss and cognitive function were examined by multivariable adjusted logistic *** Participants with hearing loss(n=451,36%)were older,more likely to be male,and have depressive symptoms than patients without hearing *** baseline,528(42%)participants were cognitively *** with hearing loss were significantly more likely to have cognitive impairment at baseline[adjusted odds ratio(OR)=1.37,95%confidence interval(CI):1.05–1.81].Among the 662 participants who did not have cognitive impairment at baseline and attended the one-year follow-up visit,106(16%)developed incident cognitive *** with,versus those without,hearing loss were significantly more likely to develop incident cognitive impairment at one year(adjusted OR=1.68,95%CI:1.07–2.64).Conclusions Hearing loss is a prevalent but under-recognized factor associated with cognitive impairment in patients with *** for hearing loss may be indicated among these patients to identify individuals at high-risk for adverse outcomes.

关键词： Atrial fibrillation Cognitive function Hearing

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Health behavior outcomes in stroke survivors prescribed wearables for atrial fibrillation detection stratified by age

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Journal of Geriatric Cardiology 2024年第3期21卷 323-330页

作者： Joanne Mathew Jordy Mehawej Ziyue Wang Taylor Orwig Eric Ding Andreas Filippaios Syed Naeem Edith Mensah Otabil Alex Hamel Kamran Noorishirazi IrinaRadu jane saczynski David D.McManus Khanh-Van Tran Division of Cardiovascular Medicine Department of MedicineUniversity of Massachusetts Chan Medical SchoolLake Avenue NorthWorcesterUSA Department of Internal Medicine Central Michigan UniversityMount PleasantUSA Department of Pharmacy and Health Systems Sciences School of PharmacyNortheastern UniversityBostonUSA Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical SchoolLake Avenue NorthWorcesterUSA

BACKGROUND Smartwatches have become readily accessible tools for detecting atrial fibrillation(AF).There remains limited data on how they affect psychosocial outcomes and engagement in older *** examine the health behavior outcomes of stroke survivors prescribed smartwatches for AF detection stratified by *** We analyzed data from the Pulsewatch study,a randomized controlled trial that enrolled patients(≥50 years)with a history of stroke or transient ischemic attack and CHA2DS2-VASc≥*** participants were equipped with a cardiac patch monitor and a smartwatch-app dyad,while control participants wore the cardiac patch monitor for up to 44 *** evaluated health behavior parameters using standardized tools,including the Consumer Health Activation Index,the Generalized Anxiety Disorder questionnaire,the 12-Item Short Form Health Survey,and wear time of participants categorized into three age groups:Group 1(ages 50-60),Group 2(ages 61-69),and Group 3(ages 70-87).We performed statistical analysis using a mixedeffects repeated measures linear regression model to examine differences amongst age *** Comparative analysis between Groups 1,2 and 3 revealed no significant differences in anxiety,patient activation,perception of physical health and wear *** use of smartwatch technology was associated with a decrease in perception of mental health for Group 2 compared to Group 1(β=-3.29,P=0.046).CONCLUSION Stroke survivors demonstrated a willingness to use smartwatches for AF ***,among these study participants,the majority did not experience negative health behavior outcomes or decreased engagement as age increased.

关键词： prescribed stratified wear

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Self-reported risk of stroke and factors associated with underestimation of stroke risk among older adults with atrial fibrillation: the SAGE-AF study

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Journal of Geriatric Cardiology 2020年第8期17卷 502-509页

作者： Jordy Mehawej jane saczynski Jerry H.Gurwitz Hawa O.Abu Benita A.Bamgbade Wei-Jia WANG Tenes Paul Katherine Trymbulak Connor Saleeba Zi-Yue WANG Catarina I.Kiefe Robert J.Goldberg David D.Mc Manus Division of Cardiovascular Medicine Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterMAUSA Department of Pharmacy and Health Systems Sciences School of PharmacyNortheastern UniversityBostonMAUSA Department of Population and Quantitative Health Sciences University of Massachusetts Medical SchoolWorcesterMAUSA Division of Geriatric Medicine and Meyers Primary Care Institute University of Massachusetts Medical SchoolWorcesterMAUSA

Background Though engaging patients with atrial fibrillation(AF) in understanding their stroke risk is encouraged by guidelines, little is known regarding AF patients' perceived stroke risk or its relationship with oral anticoagulation(OAC) use. We aim to identify factors associated with underestimation of stroke risk among older patients with AF and relate this to OAC use. Methods Data are from the ongoing SAGE(Systematic Assessment of Geriatric Elements)-AF study, which included older patients(> 65 years) with non-valvular AF and a CHA2 DS2-VASc score of ≥ 2. Participants reported their perceived risk of having a stroke without OAC. We compared the perceived risk to CHA2 DS2-VASc predicted stroke risk and classified participants as "over" or "under" estimators, and identified factors associated with underestimation of risk using multiple logistic regression. Results The average CHA2 DS2-VASc score of 915 participants(average age: 75 years, 47% female, 86% white) was 4.3 ± 1.6, 43% of participants had discordant predicted and self-reported stroke risks. Among the 376 participants at highest risk(CHA2 DS2-VASc score ≥ 5), 46% of participants underestimated their risk. Older participants(≥ 85 years) were more likely and OAC treated patients less likely to underestimate their risk of developing a future stroke than respective comparison groups. Conclusions A significant proportion of study participants misperceived their stroke risk, mostly by overestimating. Almost half of participants at high risk of stroke underestimated their risk, with older patients more likely to do so. Patients on OAC were less likely to underestimate their risk, suggesting that successful efforts to educate patients about their stroke risk may influence treatment choices.

关键词： Anticoagulation Atrial fibrillation Stroke

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