Analysis of Risk Factors Independently Associated with Cognitive Impairment in Patients with Permanent Atrial Fibrillation: A Cross-sectional Observational Study.

BACKGROUND AND OBJECTIVE: Atrial Fibrillation (AF) is associated with an increased risk of stroke and development of cognitive impairment. Our cross-sectional study aims to identify risk factors for cognitive impairment in patients with permanent AF. MATERIALS AND METHODS: 212 consecutive outpatients with history of permanent AF lasting more than 1 year were enrolled and the Short Portable Mental Status Questionnaire (SPMSQ) was used to assess cognitive impairment (number of errors ≥5). The type of antithrombotic therapy, the time in therapeutic range (TTR) in case of treatment with warfarin and the degree of heart rate (HR) control (upon Holter ECG monitoring) were also assessed. RESULTS: ROC curve analysis indicated that TTR was associated with cognitive impairment (AUC 0.85 ± 0.03; 95% CI 0.77-0.88; p < 0.0001). Multivariate logistic regression analysis showed an independent association of previous cerebrovascular or cardiovascular events (OR 7.24, 95% CI 1.37-38.25; p = 0.020), aspirin therapy instead of anticoagulant therapy (OR 24.74, 95% CI 1.27-482.12; p = 0.034), warfarin use with TTR ≤60% (OR 21.71 , 95%CI 4.35-108; p < 0.001) and an average daily HR either <60 bpm or >100 bpm (OR 6.04, 95% 1.09-33.29; p = 0.039) with cognitive impairment. CONCLUSION: Among patients with permanent AF, cognitive impairment is more frequent in those with inadequate antithrombotic therapy (aspirin therapy instead of anticoagulant therapy) and with suboptimal oral anticoagulation (TTR ≤60%) or heart rate control. Efforts should be made to optimize therapies related to these parameters.

The role of bariatric surgery for improvement of hypertension in obese patients: a retrospective study.

OBJECTIVE: Evaluate if bariatric surgery can improve hypertension (HPT) control leading to both reduction of blood pressure values and antihypertensive therapy withdrawal. METHODS: Eight-hundred and sixty-four consecutive patients who referred to our hospital, from March 2001 to February 2011, because of morbid obesity were initially enrolled in this retrospective study. To obtain two comparable groups, propensity-matching was applied. Finally, the study included 444 (51% out of initial 864 patients), 222 on diet (group D) and 222 patients undergoing surgery (group S). RESULTS: In group D, sistolic blook pressure (SBP) showed a significant increase (135 ±â€Š14 vs 138 ±â€Š11 mmHg; P = 0.006); conversely in group S, SBP decreased (130 ±â€Š14 vs 124 ±â€Š9 mmHg; P = 0.001). In group D, diastolic blood pressure (DBP) showed a significant increase (80 ±â€Š6 vs 82 ±â€Š6 mmHg; P = 0.004); conversely in group S, DBP decreased (81 ±â€Š9 vs 79 ±â€Š8 mmHg; P = 0.015). Among 136 patients with HPT, 73 (53%) withdrew antihypertensive therapy: significantly more in group S (55/63, 87%) than in group D (17/56, 23%), P < 0.001. The median weight loss was significantly higher in group S than in group D at 6 months [4 (3-7) vs 15 (10-20)], 12 months [6 (4-9) vs 19 (12-28)] and 18 months [6 (2-10) vs 20 (13-32)]. Loss of weight is greater in the subgroup with HPT having surgery. CONCLUSION: Bariatric surgery is effective to improve SBP and DBP and leads to therapy withdrawal in obese patients; these changes are directly related to the amount of weight loss.