Neurocognitive and Psychosocial Interactions in Atrial Fibrillation: Toward a Holistic Model of Care

Abstract

Background/Objectives: Psychosocial (PS) factors and cognitive dysfunction (CD) in patients with atrial fibrillation (AF) may negatively impact treatment compliance. The PS profile covers multiple psychological and socio-economic factors, although research is mostly limited to depression, anxiety, and work stress. This study assessed the prevalence of a broad range of PS factors in patients with AF and their relationship with cognitive decline. Methods: We retrospectively analyzed data from patients referred to a cardiovascular rehabilitation clinic between March 2017 and April 2023 who underwent standardized assessments of PS factors, cognition, and quality of life. Results: Of the 798 included patients, 230 (28.8%) had AF, with a mean age of 68.07 years (SD 9.60 years). Six of nine PS factors were present in more than half of the overall sample. Compared to non-AF patients, those with AF showed significantly higher levels of social isolation, depression, and hostility, whereas low socioeconomic status, family and work-related stress, and other mental disorders were more frequent in the non-AF group. CD was present in 67.4% of the total cohort and was more prevalent in AF patients with a higher PS burden. Patients with permanent AF reported the poorest health status. Conclusions: Integrating assessments of PS factors and cognition in cardiac rehabilitation is feasible and supports a more comprehensive, patient-centred model of care in AF.

Keywords: atrial fibrillation; cardiovascular disease; cardiovascular rehabilitation; cognitive dysfunction: psychosocial distress; mental health; psychosocial factor; quality of life in atrial fibrillation.

Figure 1

Distribution of psychosocial stressors by cognitive dysfunction. Abbreviations: A, anxiety; CD, cognitive dysfunction; D, depression; H, hostility; LSS, low socioeconomic status; Other, other mental disorders; PTSD, post-traumatic stress disorder; SI, social isolation; TDP, type D personality; and WFs, work and family-related stress.

Figure 2

Distribution of psychosocial stressors in patients with cognitive decline according to the presence or absence of atrial fibrillation. Abbreviations: A, anxiety; AF, atrial fibrillation; CD, cognitive dysfunction; D, depression; H, hostility; LSS, low socioeconomic status; Other, other mental disorders; PTSD, post-traumatic stress disorder; SI, social isolation; TDP, type D personality; and WFs, work and family-related stress.