Shadi Kalantarian, MD, MPH; Theodore A. Stern, MD; Moussa Mansour, MD; Jeremy N. Ruskin, MD
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, the National Center for Research Resources, or the National Institutes of Health.
Acknowledgment: The authors thank Jose Sarmiento, MD, MPH, from Harvard School of Public Health; Kasra Moazzami, MD, MPH, from Massachusetts General Hospital, who did duplicate data extraction; Hang Lee, PhD, and Brian Healy, PhD, from Harvard Catalyst, who provided biostatistical consultation; Susan Landry, who edited a draft of this manuscript; Julie Goodman, PhD, and Donald Halstead, BA, from Harvard School of Public Health, for their help and support. They also thank the following persons who provided them with additional data from their published studies: Jared Bunch, MD; Alessandra Marengoni, MD; Yan-Jiang Wang, MD, PhD; Sascha Dublin, MD, PhD; and Ruth Peters, MD.
Grant Support: By the Deane Institute for Integrative Research in Atrial Fibrillation and Stroke at Massachusetts General Hospital. This work was conducted with support from Harvard Catalyst and the Harvard Clinical and Translational Science Center (National Institutes of Health Award UL1 RR 025758 and financial contributions from Harvard University and its affiliated academic health care centers).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1971.
Requests for Single Reprints: Jeremy N. Ruskin, MD, Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, GRB 109, Boston, MA 02114; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Kalantarian: Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Jackson 1302, Boston, MA 02114.
Dr. Stern: Psychiatry Associates-Inpatient Consult, 55 Fruit Street, WRN 605, Boston, MA 02114-2696.
Drs. Mansour and Ruskin: Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, GRB 109, Boston, MA 02114.
Author Contributions: Conception and design: S. Kalantarian, T.A. Stern, J.N. Ruskin.
Analysis and interpretation of the data: S. Kalantarian, J.N. Ruskin.
Drafting of the article: S. Kalantarian, T.A. Stern, J.N. Ruskin.
Critical revision of the article for important intellectual content: S. Kalantarian, T.A. Stern, M. Mansour, J.N. Ruskin.
Final approval of the article: T.A. Stern, J.N. Ruskin.
Statistical expertise: S. Kalantarian.
Administrative, technical, or logistic support: J.N. Ruskin.
Collection and assembly of data: S. Kalantarian.
Kalantarian S, Stern TA, Mansour M, Ruskin JN. Cognitive Impairment Associated With Atrial Fibrillation: A Meta-analysis. Ann Intern Med. 2013;158:338-346. doi: 10.7326/0003-4819-158-5-201303050-00007
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Published: Ann Intern Med. 2013;158(5_Part_1):338-346.
Atrial fibrillation (AF) has been linked with an increased risk for cognitive impairment and dementia.
To complete a meta-analysis of studies examining the association between AF and cognitive impairment.
Search of MEDLINE, PsycINFO, Cochrane Library, CINAHL, and EMBASE databases and hand search of article references.
Prospective and nonprospective studies reporting adjusted risk estimates for the association between AF and cognitive impairment.
Two abstracters independently extracted data on study characteristics, risk estimates, methods of AF and outcome ascertainment, and methodological quality.
Twenty-one studies were included in the meta-analysis. Atrial fibrillation was significantly associated with a higher risk for cognitive impairment in patients with first-ever or recurrent stroke (relative risk [RR], 2.70 [95% CI, 1.82 to 4.00]) and in a broader population including patients with or without a history of stroke (RR, 1.40 [CI, 1.19 to 1.64]). The association in the latter group remained significant independent proof of clinical stroke history (RR, 1.34 [CI, 1.13 to 1.58]). However, there was significant heterogeneity among studies of the broader population (I2 = 69.4%). Limiting the analysis to prospective studies yielded similar results (RR, 1.36 [CI, 1.12 to 1.65]). Restricting the analysis to studies of dementia eliminated the significant heterogeneity (P = 0.137) but did not alter the pooled estimate substantially (RR, 1.38 [CI, 1.22 to 1.56]).
There is an inherent bias because of confounding variables in observational studies. There was significant heterogeneity among included studies.
Evidence suggests that AF is associated with a higher risk for cognitive impairment and dementia, with or without a history of clinical stroke. Further studies are required to elucidate the association between AF and subtypes of dementia as well as the cause of cognitive impairment.
Deane Institute for Integrative Research in Atrial Fibrillation and Stroke at the Massachusetts General Hospital.
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Cardiology, Dementia, Neurology, Rhythm Disorders and Devices, Stroke.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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