Cardiology Clinical Practice Guidelines: 2018 Midyear Review

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO

Disclosures

June 28, 2018

In This Article

Arrhythmia/Cognitive Function

European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society

Preventive measures of cognitive dysfunction in patients with atrial fibrillation

Appropriate anticoagulation in patients with AF and stroke risk factors should be applied for the prevention of cognitive dysfunction.

Consider a non-vitamin K antagonist oral anticoagulant (NOAC) instead of vitamin K antagonist (VKA) when using oral anticoagulation for the prevention of stroke in AF, which may have a beneficial effect on subsequent cognitive disorders.

In patients with AF managed with long-term VKA, a high anticoagulation time in therapeutic range may be beneficial for optimal prevention of new-onset dementia.

General health measures (prevention of smoking, hypertension, obesity and diabetes, sleep apnea, and appropriate control of all risk factors) may reduce the concomitant risks of AF (new onset or recurrences) and stroke, with a putative benefit on cognitive function.

Prevention of cognitive dysfunction in AF may include general measures proposed in vascular dementia or Alzheimer's disease.

Cognitive assessment should be performed in AF patients where there is suspicion of cognitive impairment.

Pharmacologic interventions

In relation to AF management, oral anticoagulation (early identification of appropriate candidates, improving drug adherence, avoiding warfarin in those with poor TTR (time in therapeutic range), and optimal TTR management); rhythm control; antihypertensive treatment; treatment of concomitant heart failure.

Non-specific pharmacologic interventions: glycemic control, hormone replacement therapy, avoid aspirin therapy unless specific clinical indication present.

Alzheimer's disease-specific pharmacologic interventions.

Multifactorial vascular risk factor management

Target blood pressure, cholesterol, diabetes, sleep apnea, obesity via diet, medication, smoking cessation, and physical activity.

Nutritional interventions

Low levels of vitamin D, B12, and folate increase risk, but the value of supplementation remains unproven.

Calcium supplementation in women has been associated with increased dementia risk. The value of modulating cognitive function based on educational interventions is uncertain.

Weight loss in obesity.

References

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