Impact of prolonged hospitalization and inadequate anticoagulation on cognitive decline in older patients with atrial fibrillation.

BACKGROUND AND

OBJECTIVE

Atrial fibrillation (AF) and prolonged hospitalization are known risk factors for cognitive decline (CD). However, whether anticoagulation quality during admission is associated with differences in CD risk among geriatric patients remains unknown. The objective is to evaluate the association between anticoagulation profile and the frequency of new-onset CD in older hospitalized patients with AF.

MATERIAL AND

METHODS

Ambispective observational study including 254 patients aged ≥80 years with AF admitted to an acute geriatric unit (2019-2022). The retrospective phase included the collection of baseline clinical variables from electronic health records; the prospective phase comprised scheduled cognitive follow-up at 6 and 12 months after discharge. Hospital length of stay and anticoagulation quality (Adequate, Inadequate/Underdosing, or No treatment) were analyzed. The primary outcome was the cumulative frequency of new-onset CD at 12 months.

RESULTS

The cumulative frequency of CD was 18.9%. Patients with adequate anticoagulation had a lower frequency (13.5%; 95%CI 8.3-18.7) compared with those with inadequate dosing (27.9%; 95%CI 18.2-37.6) and no treatment (33.9%; 95%CI 21.4-46.4). In multivariable analysis, inadequate anticoagulation (HR 1.78; 95%CI 1.15-2.85) and absence of treatment (HR 2.25; 95%CI 1.35-3.65) were independently associated with CD, as was very prolonged hospital stay (HR 2.41; 95%CI 1.45-3.95). Adequate anticoagulation was associated with greater deterioration-free survival even among patients with prolonged stays.

CONCLUSIONS

Prolonged hospitalization and inadequate or absent anticoagulation were associated with a higher frequency of new-onset cognitive decline. Optimizing anticoagulation represents a recommended and timely strategy associated with cognitive preservation in older hospitalized patients.