Cognitive Impairment Is Independently Associated with Non-Adherence to Antithrombotic Therapy in Older Patients with Atrial Fibrillation

Hyun-Joo Seong,Bo-Hwan Kim,Youn-Jung Son,Kyounghoon Lee

doi:10.3390/ijerph16152698

Abstract

Atrial Fibrillation (AF) patients could reduce their risk of stroke by using oral antithrombotic therapy. However, many older people with AF experience cognitive impairment and have limited health literacy, which can lead to non-adherence to antithrombotic treatment. This study aimed to investigate the influence of cognitive impairment and health literacy on non-adherence to antithrombotic therapy. The study performed a secondary analysis of baseline data from a cross-sectional survey of AF patients’ self-care behaviors at a tertiary university hospital in 2018. Data were collected from a total of 277 AF patients aged 65 years and older, through self-reported questionnaires administered by face-to-face interviews. Approximately 50.2% of patients were non-adherent to antithrombotic therapy. Multiple logistic regression analysis revealed that cognitive impairment independently increased the risk of non-adherence to antithrombotic therapy (odds ratio = 2.628, 95% confidence interval = 1.424–4.848) after adjustment for confounding factors. However, health literacy was not associated with non-adherence to antithrombotic therapy. Cognitive impairment is a significant risk factor for poor adherence to antithrombotic therapy. Thus, health professionals should periodically assess both cognitive function after AF diagnosis and adherence to medication in older patients. Further studies are needed to identify the factors that affect cognitive decline and non-adherence among AF patients.

Highlights

Atrial fibrillation (AF) is the most common type of arrhythmia and prevalent among older people [1,2]
Data were collected from a total of 277 AF patients aged 65 years and older, through self-reported questionnaires administered by face-to-face interviews
Our study highlights that cognitive impairment is independently associated with non-adherence to antithrombotic therapy in older people with AF

Summary

Introduction

Atrial fibrillation (AF) is the most common type of arrhythmia and prevalent among older people [1,2]. A number of studies have shown that older adults with AF have a fourto five-fold higher risk of stroke [6,7,8]. For the majority of elderly patients, long-term use of antithrombotic medications is required to prevent the risk of stroke, which can be classified into antiplatelet agents and anticoagulants [3]. Antiplatelet agents, such as aspirin, inhibit platelet aggregation and anticoagulants, such as warfarin or non-vitamin K antagonist oral anticoagulants (NOACs), prevent thrombus by interfering with hemostasis [9].

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