Background: It is well known that atrial fibrillation (AF) and chronic kidney disease (CKD) are associated with a higher risk of stroke, and new evidence links AF to cognitive impairment, independently from an overt stroke (CI). Our aim was to investigate, assuming an underlying role of atrial microembolism, the impact of CI and CKD in elderly hospitalized patients with AF. Methods: We retrospectively analyzed the data collected on elderly patients in 66 Italian hospitals, in the frame of the REPOSI project. We analyzed the clinical characteristics of patients with AF and different degrees of CI. Multivariate logistic analysis was used to explore the relationship between variables and mortality. Results: Among the 1384 patients enrolled, 321 had AF. Patients with AF were older, had worse CI and disability and higher rates of stroke, hypertension, heart failure, and CKD, and less than 50% were on anticoagulant therapy. Among patients with AF, those with worse CI and those with lower estimated glomerular filtration rate (eGFR) had a higher mortality risk (odds ratio 1.13, p = 0.006). Higher disability levels, older age, higher systolic blood pressure, and higher eGFR were related to lower probability of oral anticoagulant prescription. Lower mortality rates were found in patients on oral anticoagulant therapy. Conclusions: Elderly hospitalized patients with AF are more likely affected by CI and CKD, two conditions that expose them to a higher mortality risk. Oral anticoagulant therapy, still underused and not optimally enforced, may afford protection from thromboembolic episodes that probably concur to the high mortality.

Mannucci, P., Nobili, A., Tettamanti, M., Pasina, L., Franchi, C., Salerno, F., et al. (2015). Brain and kidney, victims of atrial microembolism in elderly hospitalized patients? Data from the REPOSI study. EUROPEAN JOURNAL OF INTERNAL MEDICINE, 26(4), 243-249 [10.1016/j.ejim.2015.02.018].

Brain and kidney, victims of atrial microembolism in elderly hospitalized patients? Data from the REPOSI study

ANNONI, GIORGIO
Membro del Collaboration Group
;
ZAZZETTA, SARA
Membro del Collaboration Group
;
2015

Abstract

Background: It is well known that atrial fibrillation (AF) and chronic kidney disease (CKD) are associated with a higher risk of stroke, and new evidence links AF to cognitive impairment, independently from an overt stroke (CI). Our aim was to investigate, assuming an underlying role of atrial microembolism, the impact of CI and CKD in elderly hospitalized patients with AF. Methods: We retrospectively analyzed the data collected on elderly patients in 66 Italian hospitals, in the frame of the REPOSI project. We analyzed the clinical characteristics of patients with AF and different degrees of CI. Multivariate logistic analysis was used to explore the relationship between variables and mortality. Results: Among the 1384 patients enrolled, 321 had AF. Patients with AF were older, had worse CI and disability and higher rates of stroke, hypertension, heart failure, and CKD, and less than 50% were on anticoagulant therapy. Among patients with AF, those with worse CI and those with lower estimated glomerular filtration rate (eGFR) had a higher mortality risk (odds ratio 1.13, p = 0.006). Higher disability levels, older age, higher systolic blood pressure, and higher eGFR were related to lower probability of oral anticoagulant prescription. Lower mortality rates were found in patients on oral anticoagulant therapy. Conclusions: Elderly hospitalized patients with AF are more likely affected by CI and CKD, two conditions that expose them to a higher mortality risk. Oral anticoagulant therapy, still underused and not optimally enforced, may afford protection from thromboembolic episodes that probably concur to the high mortality.
Articolo in rivista - Articolo scientifico
Aged; Anticoagulants; Atrial fibrillation; Dementia; Renal insufficiency, chronic; Stroke;
Aged; Anticoagulants; Atrial fibrillation; Dementia; Renal insufficiency, chronic; Stroke; Internal Medicine
English
243
249
7
Annoni Giorgio e Zazzetta Sara on behalf of REPOSI Investigators
Mannucci, P., Nobili, A., Tettamanti, M., Pasina, L., Franchi, C., Salerno, F., et al. (2015). Brain and kidney, victims of atrial microembolism in elderly hospitalized patients? Data from the REPOSI study. EUROPEAN JOURNAL OF INTERNAL MEDICINE, 26(4), 243-249 [10.1016/j.ejim.2015.02.018].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/91806
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