Close-up image of senior woman holding her chest.
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A new study examined how treatments for atrial fibrillation (Afib) affected cognitive decline and frailty. Treating heart rate compared to rhythm was linked to a greater rate of cognitive decline, the study found. 

Cognitive impairment is linked with Afib, which is having an irregular heart rhythm. Doctors typically target heart rate and rhythm control when treating the heart condition.  

The report was published May 14 in the Journal of the American Geriatrics Society. The team enrolled 972 people between 2016 and 2018, and followed up on them for two years. The average age of people was 75 years old. Participants were put into groups based on rate (42%) or rhythm control (58%) treatment strategies. The team also measured cognitive function and frailty status.

Participants in the rate control group were older, more likely to have persistent Afib, prior stroke, be treated with warfarin, and have cognitive impairment at the start of the study. They were 1.5 times more likely to be cognitively impaired over the two-year follow-up period, and had greater decline in cognitive function compared to people in the rhythm control group. Interestingly, there weren’t significant changes in frailty between the two groups.

Specifically, people treated for rate were less likely to have paroxysmal Afib and had shorter durations of Afib. The rate control group had a higher risk of stroke and was more likely to have a history of peripheral vascular disease and stroke. It wasn’t possible to determine the timing of rhythm control changes and when comorbidities developed, the authors noted. 

“Future studies comparing these two strategies should incorporate cognitive function as a clinical outcome,” the authors wrote.

“While randomized control studies comparing the two treatment strategies would provide the greatest evidence for one strategy over the other, in the current era of Afib management, such randomized control studies may be difficult to perform,” they added. 

The team would like to see future studies have a longer follow-up period as well as measures to assess whether rhythm control prevents the onset and/or progression of cognitive impairment in older adults.