The Influence of Treatment Strategies on Cognitive Functions in Patients with Paroxysmal and Persistent Atrial Fibrillation
To assess the cognitive functions (CF) in patients with atrial fibrillation (AF) depending on the treatment strategy and the features of outpatient care, we have examined 96 patients. Management of patients was carried out in two common strategies: the rehabilitation and subsequent maintenance of sinus rhythm (SR), and preservation of AF with control of heart rate (HR). At the first stage, we have studied the factors influencing the choice of treatment strategy in patients hospitalized with AF paroxysm. The specialized scales were used to evaluate the tolerance of the AF, СF level, anxiety and depression. The second phase consisted in the outpatient monitoring of patients. The patients were randomized into two following groups: 1 — group of active follow-up, 2 — group of standard follow-up. The choice of treatment strategy in patients with AF was determined by factors such as age, alcohol abuse, the size of the left atrium, the form of AF (paroxysmal/persistent), as well as the wishes of the patient. During the direct survey, as the most important factors when choosing the strategy of HR control, doctors indicated the duration of AF attack more than 1 year and satisfactory tolerability of the AF. When deciding about how to restore SR, the most important were the desire of the patient, the absence of significant dilation of the left atrium, rare (less than 4 times a year) paroxysms and young age of patients. СF of patients with AF, whose treatment is carried out within the strategy of HR control, was significantly lower than in patients, who restore and maintain SR. In addition, among this group of patients the prevalence of depression was significantly higher. Dynamics of CF in patients with AF did not depend on the treatment strategies, but depended on the sex, baseline CF, the nature of outpatient care and social factors (living without family). Patients with higher level of CF had greater adherence to the treatment and were less prone to self-cancellation of amiodarone (during 24 months of follow-up).
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