Study Questions Link Between Heart Procedures and Cognitive Decline

According to new research, both immediate and long-term cognitive impairment in older adults resulting from invasive heart procedures may not be particularly common.
 
In an effort to evaluate the risks older adults face for intermediate- and long-term cognitive decline after cardiovascular procedures—which the authors say are poorly understood—a team of researchers reviewed 17 randomized controlled trials and 4 cohort studies involving adults aged 65 years or older, at least 3 months after coronary or carotid revascularization, cardiac valve procedures, or ablation for atrial fibrillation.
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Overall, the investigators found that cognitive function did not differ between patients undergoing heart procedures and those who received medical management or alternative procedures, nor did cognitive function within treatment groups between baseline and follow-up, which was typically up to 1 year after surgery.
 
Given the findings, the authors concluded that cognitive impairment in older adults that can be attributed to the cardiovascular procedures they studied—on- and off-pump coronary artery bypass grafting (CABG), hypothermic and normothermic CABG, or CABG and medical management—“may be uncommon.”
 
While noting that “more high-quality research is needed” in this area, the findings “may allow primary care practitioners who discuss the possible risks and benefits of these specific cardiovascular procedures to cautiously reassure patients that they may not cause persistent cognitive problems,” says Howard A. Fink, MD, MPH, a staff physician at the Minneapolis VA Health Care System, and co-author of the study.
 
“While this is already a very cautious statement,” says Fink, “it should be accompanied by acknowledgement that there is still significant uncertainty about this conclusion, and that uncertainty is even greater about cognitive outcomes after atrial fibrillation ablation and cardiac valve repairs, and post-procedure cognitive outcomes in the oldest [patients], women, and in patients with substantial pre-procedure cognitive impairment.”
 
—Mark McGraw
 
Reference
 
Fink H, Hemmy L, et al. Cognitive Outcomes After Cardiovascular Procedures in Older Adults. Ann Intern Med. 2015.