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Original article

Vol. 147 No. 2728 (2017)

Design of the Swiss Atrial Fibrillation Cohort Study (Swiss-AF): structural brain damage and cognitive decline among patients with atrial fibrillation

DOI
https://doi.org/10.4414/smw.2017.14467
Cite this as:
Swiss Med Wkly. 2017;147:w14467
Published
10.07.2017

Summary

BACKGROUND

Several studies found that patients with atrial fibrillation (AF) have an increased risk of cognitive decline and dementia over time. However, the magnitude of the problem, associated risk factors and underlying mechanisms remain unclear.

METHODS

This article describes the design and methodology of the Swiss Atrial Fibrillation (Swiss-AF) Cohort Study, a prospective multicentre national cohort study of 2400 patients across 13 sites in Switzerland. Eligible patients must have documented AF. Main exclusion criteria are the inability to provide informed consent and the presence of exclusively short episodes of reversible forms of AF. All patients undergo extensive phenotyping and genotyping, including repeated assessment of cognitive functions, quality of life, disability, electrocardiography and cerebral magnetic resonance imaging. We also collect information on health related costs, and we assemble a large biobank. Key clinical outcomes in Swiss-AF are death, stroke, systemic embolism, bleeding, hospitalisation for heart failure and myocardial infarction. Information on outcomes and updates on other characteristics are being collected during yearly follow-up visits.

RESULTS

Up to 7 April 2017, we have enrolled 2133 patients into Swiss-AF. With the current recruitment rate of 15 to 20 patients per week, we expect that the target sample size of 2400 patients will be reached by summer 2017.

CONCLUSION

Swiss-AF is a large national prospective cohort of patients with AF in Switzerland. This study will provide important new information on structural and functional brain damage in patients with AF and on other AF related complications, using a large variety of genetic, phenotypic and health economic parameters.

References

  1. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370–5. doi:.https://doi.org/10.1001/jama.285.18.2370
  2. Krijthe BP, Kunst A, Benjamin EJ, Lip GY, Franco OH, Hofman A, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34(35):2746–51. doi:.https://doi.org/10.1093/eurheartj/eht280
  3. Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114(2):119–25. doi:.https://doi.org/10.1161/CIRCULATIONAHA.105.595140
  4. Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98(10):946–52. doi:.https://doi.org/10.1161/01.CIR.98.10.946
  5. Conen D, Chae CU, Glynn RJ, Tedrow UB, Everett BM, Buring JE, et al. Risk of death and cardiovascular events in initially healthy women with new-onset atrial fibrillation. JAMA. 2011;305(20):2080–7. doi:.https://doi.org/10.1001/jama.2011.659
  6. Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107(23):2920–5. doi:.https://doi.org/10.1161/01.CIR.0000072767.89944.6E
  7. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983–8. doi:.https://doi.org/10.1161/01.STR.22.8.983
  8. Kraft E, Marti M, Werner S, Sommer H. Cost of dementia in Switzerland. Swiss Med Wkly. 2010;140:w13093.
  9. Kwok CS, Loke YK, Hale R, Potter JF, Myint PK. Atrial fibrillation and incidence of dementia: a systematic review and meta-analysis. Neurology. 2011;76(10):914–22. doi:.https://doi.org/10.1212/WNL.0b013e31820f2e38
  10. Santangeli P, Di Biase L, Bai R, Mohanty S, Pump A, Cereceda Brantes M, et al. Atrial fibrillation and the risk of incident dementia: a meta-analysis. Heart Rhythm. 2012;9(11):1761–8. doi:.https://doi.org/10.1016/j.hrthm.2012.07.026
  11. Kalantarian S, Stern TA, Mansour M, Ruskin JN. Cognitive impairment associated with atrial fibrillation: a meta-analysis. Ann Intern Med. 2013;158(5 Pt 1):338–46. doi:.https://doi.org/10.7326/0003-4819-158-5-201303050-00007
  12. Thacker EL, McKnight B, Psaty BM, Longstreth WT, Jr, Sitlani CM, Dublin S, et al. Atrial fibrillation and cognitive decline: a longitudinal cohort study. Neurology. 2013;81(2):119–25. doi:.https://doi.org/10.1212/WNL.0b013e31829a33d1
  13. Das RR, Seshadri S, Beiser AS, Kelly-Hayes M, Au R, Himali JJ, et al. Prevalence and correlates of silent cerebral infarcts in the Framingham offspring study. Stroke. 2008;39(11):2929–35. doi:.https://doi.org/10.1161/STROKEAHA.108.516575
  14. van Norden AG, van den Berg HA, de Laat KF, Gons RA, van Dijk EJ, de Leeuw FE. Frontal and temporal microbleeds are related to cognitive function: the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC) Study. Stroke. 2011;42(12):3382–6. doi:.https://doi.org/10.1161/STROKEAHA.111.629634
  15. Ovbiagele B, Saver JL, Sanossian N, Salamon N, Villablanca P, Alger JR, et al. Predictors of cerebral microbleeds in acute ischemic stroke and TIA patients. Cerebrovasc Dis. 2006;22(5-6):378–83. doi:.https://doi.org/10.1159/000094855
  16. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, et al.; European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31(19):2369–429. doi:.https://doi.org/10.1093/eurheartj/ehq278
  17. Smith SM, Jenkinson M, Woolrich MW, Beckmann CF, Behrens TE, Johansen-Berg H, et al. Advances in functional and structural MR image analysis and implementation as FSL. Neuroimage. 2004;23(Suppl 1):S208–19. doi:.https://doi.org/10.1016/j.neuroimage.2004.07.051
  18. Smith SM, Zhang Y, Jenkinson M, Chen J, Matthews PM, Federico A, et al. Accurate, robust, and automated longitudinal and cross-sectional brain change analysis. Neuroimage. 2002;17(1):479–89. doi:.https://doi.org/10.1006/nimg.2002.1040
  19. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9. doi:.https://doi.org/10.1111/j.1532-5415.2005.53221.x
  20. War Department Adjutant General’s Office. Army Individual Test Battery: Manual of Directions and Scoring. Washington D.C.: War Department Adjutant General's Office. 1944.
  21. Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, et al. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology. 1989;39(9):1159–65. doi:.https://doi.org/10.1212/WNL.39.9.1159
  22. Wechsler D. Wechsler Adult Intelligence Scale–Revised Manual New York: Psychological Corporation. 1981.
  23. Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS) Recent evidence and development of a shorter version. In: Brink TL, editor. Clinical Gerontology: A Guide to Assessment and Intervention. New York: The Haworth Press. 1986:165-73.
  24. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, et al.; CORONARY Investigators. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med. 2013;368(13):1179–88. doi:.https://doi.org/10.1056/NEJMoa1301228
  25. Räsänen P, Roine E, Sintonen H, Semberg-Konttinen V, Ryynänen OP, Roine R. Use of quality-adjusted life years for the estimation of effectiveness of health care: A systematic literature review. Int J Technol Assess Health Care. 2006;22(2):235–41. doi:.https://doi.org/10.1017/S0266462306051051
  26. Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J. 1965;14:61–5.
  27. Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subtypes. Cerebrovasc Dis. 2009;27(5):493–501. doi:.https://doi.org/10.1159/000210432
  28. Schulman S, Kearon C ; Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3(4):692–4. doi:.https://doi.org/10.1111/j.1538-7836.2005.01204.x
  29. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al.; Writing Group on the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction; ESC Committee for Practice Guidelines (CPG). Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2551–67. doi:.https://doi.org/10.1093/eurheartj/ehs184
  30. Ball J, Carrington MJ, Stewart S ; SAFETY investigators. Mild cognitive impairment in high-risk patients with chronic atrial fibrillation: a forgotten component of clinical management? Heart. 2013;99(8):542–7. doi:.https://doi.org/10.1136/heartjnl-2012-303182
  31. Conen D, Tedrow UB, Koplan BA, Glynn RJ, Buring JE, Albert CM. Influence of systolic and diastolic blood pressure on the risk of incident atrial fibrillation in women. Circulation. 2009;119(16):2146–52. doi:.https://doi.org/10.1161/CIRCULATIONAHA.108.830042
  32. Tedrow UB, Conen D, Ridker PM, Cook NR, Koplan BA, Manson JE, et al. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women’s health study). J Am Coll Cardiol. 2010;55(21):2319–27. doi:.https://doi.org/10.1016/j.jacc.2010.02.029
  33. Conen D, Wong JA, Sandhu RK, Cook NR, Lee IM, Buring JE, et al. Risk of Malignant Cancer Among Women With New-Onset Atrial Fibrillation. JAMA Cardiol. 2016;1(4):389–96. doi:.https://doi.org/10.1001/jamacardio.2016.0280

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