Consensus Statement of International Heart Rhythm Societies on how to limit cognitive decline in AF
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 published an expert consensus statement on cognitive function in arrhythmias. The consensus is based on a thorough review of the medical literature regarding this topic.
The international writing group aimed to describe the impact of different types of arrhythmias on cognitive function, to highlight possible risk markers for cognitive decline and to formulate implications for clinical practice regarding follow-up methods, prevention and treatment strategies. The objective of the document is 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.
Recent studies have suggested possible associations between cognitive decline and atrial fibrillation (AF). The scientific literature on AF and cognitive function was therefore reviewed. Based on this, recommendations are done to assess cognitive function and prevention of cognitive decline in AF patients. Associations between other arrhythmias and cognitive dysfunctions are also discussed. For quick reference, sub-chapters are followed by a short section on consensus recommendations. The document concludes with a summary of consensus statements, current knowledge gaps, and future directions of research.
An ESC press release on the document notes that the document states that AF is associated with a higher risk for cognitive impairment and dementia, even in the absence of apparent stroke. This may be because AF is linked with a more than two-fold risk of silent strokes. The accumulation of silent strokes and the associated brain injuries over time may contribute to cognitive impairment.
Stroke prevention with oral anticoagulant drugs is the main priority in the management of patients with AF. The consensus document says that oral anticoagulation may reduce the risk of dementia. Adopting a healthy lifestyle may also reduce the risk of cognitive decline in patients with atrial fibrillation. This includes not smoking and preventing or controlling hypertension, obesity, diabetes, and sleep apnoea.