Cognitive Impairment Is Independently Associated with Non-Adherence to Antithrombotic Therapy in Older Patients with Atrial Fibrillation
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Participants
2.2. Instruments
2.2.1. Socio-Demographic and Disease-Related Characteristics of Patients
2.2.2. Cognitive Function
2.2.3. Health Literacy
2.2.4. Adherence to Antithrombotic Therapy
2.3. Ethical Considerations and Data Collection
2.4. Data Analysis
3. Results
3.1. Socio-Demographic and Disease Characteristics of Patients with AF
3.2. Level of Cognitive Function, Health Literacy, and Adherence to Antithrombotic Therapy
3.3. Differences in Adherence to Antithrombotic Therapy according to General Characteristics, Cognitive Function, and Health Literacy
3.4. Factors Influencing Non-Adherence to Antithrombotic Therapy in Older Patients with AF
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Characteristics | Categories | n (%) | Mean ± SD |
---|---|---|---|
Age (years) | 65–70 | 89 (32.1) | 74.2 ± 7.2 |
70–79 | 126 (45.5) | ||
≥80 | 62 (22.4) | ||
Gender | Men | 164 (59.2) | |
Women | 113 (40.8) | ||
Education | Below elementary school | 95 (34.3) | |
Middle school | 69 (24.9) | ||
High school | 77 (27.8) | ||
College | 36 (13.0) | ||
Job | Yes | 58 (20.9) | |
Spouse | Yes | 190 (68.6) | |
Years after diagnosis of AF | 1–2 | 40 (14.4) | 7.9 ± 6.9 |
3–4 | 42 (15.2) | ||
≥5 | 195 (70.4) | ||
Type of AF | Paroxysmal | 170 (61.4) | |
Persistent and permanent | 107 (39.6) | ||
CHA2DS2-VASc score | 1 | 21 (7.6) | 3.8 ± 1.6 |
≥2 | 256 (92.4) | ||
HAS-BLED score | 1–2 | 53 (19.1) | 3.2 ± 0.9 |
≥3 | 224 (80.9) | ||
Hypertension | Yes | 221 (79.8) | |
Diabetes | Yes | 79 (28.5) | |
Coronary artery disease | Yes | 90 (32.5) | |
Heart failure | Yes | 110 (39.7) | |
Stroke | Yes | 57 (20.6) | |
Aspirin | Yes | 122 (44.0) | |
Warfarin | Yes | 99 (35.7) | |
NOACs | Yes | 69 (28.5) |
Variables (Cut-Off) | n (%) | Min–Max | Mean ± SD |
---|---|---|---|
Cognitive function | 14–30 | 25.8 ± 3.6 | |
Impaired (<24) | 197 (71.1) | ||
Normal (≥24) | 80 (28.9) | ||
Health literacy | 0–12 | 7.9 ± 3.5 | |
Inadequate (≤6) | 78 (28.1) | ||
Marginal (7–10) | 126 (45.5) | ||
Adequate (11–12) | 73 (26.4) | ||
Antithrombotic therapy | 3–6 | 5.3 ± 0.8 | |
Non-adherence (1–5) | 139 (50.2) | ||
Adherence (6) | 138 (49.8) |
Characteristics | Non-Adherence (n = 139) | Adherence (n = 138) | χ2 (p) |
---|---|---|---|
Frequency (%) | Frequency (%) | ||
Age (years) | |||
65–70 | 31 (34.8) | 58 (65.2) | 15.15 (0.001) |
70–79 | 67 (53.2) | 59 (46.8) | |
≥80 | 41 (66.1) | 21 (33.9) | |
Gender | |||
Men | 76 (46.3) | 88 (53.7) | 2.37 (0.124) |
Women | 63 (55.8) | 50 (44.2) | |
Education | |||
Below elementary school | 63 (66.3) | 32 (33.7) | 16.18 (0.001) |
Middle school | 32 (46.4) | 37 (53.6) | |
High school | 31 (40.3) | 46 (59.7) | |
College | 13 (36.1) | 23 (63.9) | |
Job, yes | 21 (36.2) | 37 (63.8) | 5.73 (0.017) |
Spouse, yes | 83 (43.7) | 107 (56.3) | 10.21 (0.001) |
Years after diagnosis of AF | |||
1–2 | 20 (50.0) | 20 (50.0) | 0.01 (0.953) |
3–4 | 22 (52.4) | 20 (47.6) | |
≥5 | 97(69.8) | 98 (50.3) | |
Type of AF | |||
Paroxysmal | 79 (46.5) | 91 (53.5) | 3.70 (0.296) |
Persistent and permanent | 60 (56.7) | 47 (43.3) | |
CHA2DS2-VASc score | |||
1 | 5 (23.8) | 16 (76.2) | 6.32 (0.012) |
≥2 | 134 (52.3) | 122 (47.7) | |
HAS-BLED score | |||
1–2 | 24 (45.3) | 29 (54.7) | 0.63 (0.428) |
≥3 | 115 (51.3) | 109 (48.7) | |
Hypertension, yes | 111 (50.2) | 110 (49.8) | 0.01 (0.976) |
Diabetes, yes | 43 (54.4) | 36 (45.6) | 0.79 (0.372) |
Coronary artery disease, yes | 46 (51.1) | 44 (48.9) | 0.05 (0.830) |
Heart failure, yes | 60 (54.5) | 50 (45.5) | 1.39 (0.238) |
Stroke, yes | 31 (54.4) | 26 (45.6) | 0.51 (0.476) |
Aspirin, yes | 55 (45.1) | 67 (54.9) | 2.27 (0.132) |
Warfarin, yes | 46 (46.5) | 53 (53.5) | 0.95 (0.356) |
NOACs, yes | 47 (59.5) | 32 (40.5) | 3.83 (0.051) |
Cognitive function | |||
Impaired | 58 (72.5) | 22 (27.5) | 22.42 (<0.001) |
Normal | 81 (41.1) | 116 (58.9) | |
Health literacy | |||
Inadequate | 56 (71.9) | 22 (28.2) | 22.00 (<0.001) |
Marginal | 57 (45.2) | 69 (54.8) | |
Adequate | 26 (35.6) | 47 (64.4) |
Variables | Categories | Univariate | Multivariate | ||
---|---|---|---|---|---|
OR (95% CI) | p | OR (95% CI) | p | ||
Age (year) | <80 | 1 | 1 | ||
≤79 | 2.33 (1.291–4.207) | 0.005 | 1.24 (0.621–2.459) | 0.546 | |
Education | Above high school | 1 | 1 | ||
Below middle school | 2.17 (1.332–3.549) | 0.002 | 1.45 (0.843–2.493) | 0.179 | |
Job | Yes | 1 | 1 | ||
No | 2.06 (1.132–3.742) | 0.018 | 1.29 (0.660–2.522) | 0.457 | |
Spouse | Yes | 1 | 1 | ||
No | 2.33 (1.379–3.933) | 0.002 | 1.51 (0.830–2.737) | 0.178 | |
CHA2DS2-VASc score | 1 | 1 | 1 | ||
≥2 | 3.52 (1.250–9.882) | 0.017 | 1.75 (0.573–5.356) | 0.326 | |
Cognitive function | Normal | 1 | 1 | ||
Impaired | 3.78 (2.142–6.656) | <0.001 | 2.63 (1.424–4.848) | 0.002 | |
Health literacy | Adequate | 1 | 1 | ||
Marginal and inadequate | 2.25 (1.291–3.902) | 0.004 | 1.45 (0.790–2.644) | 0.232 |
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Seong, H.-J.; Lee, K.; Kim, B.-H.; Son, Y.-J. Cognitive Impairment Is Independently Associated with Non-Adherence to Antithrombotic Therapy in Older Patients with Atrial Fibrillation. Int. J. Environ. Res. Public Health 2019, 16, 2698. https://doi.org/10.3390/ijerph16152698
Seong H-J, Lee K, Kim B-H, Son Y-J. Cognitive Impairment Is Independently Associated with Non-Adherence to Antithrombotic Therapy in Older Patients with Atrial Fibrillation. International Journal of Environmental Research and Public Health. 2019; 16(15):2698. https://doi.org/10.3390/ijerph16152698
Chicago/Turabian StyleSeong, Hyun-Joo, Kyounghoon Lee, Bo-Hwan Kim, and Youn-Jung Son. 2019. "Cognitive Impairment Is Independently Associated with Non-Adherence to Antithrombotic Therapy in Older Patients with Atrial Fibrillation" International Journal of Environmental Research and Public Health 16, no. 15: 2698. https://doi.org/10.3390/ijerph16152698