Atrial fibrillation and depressive symptoms in the elderly: an association with age, CHA2DS2-VASc score and physical performance

Background. Atrial fibrillation (AF) is the most frequent sustained arrhythmia found in clinical practice. Its prevalence significantly grows with age. The proportion of elderly individuals with depression varies between 4.2 and 10.6% according to the different criteria used for diagnosis. Interestingly, AF and depression synergistically act to increase mortality. Purpose. Aim of this study was to identify the clinical variables associated with depressive symptoms in elderly individuals with persistent AF. Methods. All patients consecutively admitted in a Day-Hospital setting to undergo electrical cardioversion of AF were enrolled in the study. No exclusion criteria were specified. Population was studied with instruments exploring neurocognitive performance (Mini-Mental State Examination - MMSE; range: 0-30; abnormal values <27) and functional status (Short Physical Performance Battery; range: 0-12; abnormal values <10). With these tools, a better condition is expressed by higher scores. The presence of depressive symptoms was assessed with the Geriatric Depression Scale (GDS; 15-item form; abnormal values >5). In this case, lower scores identified a healthier emotional profile. Results. Between January 2018 and August 2019, 111 patients were evaluated (age: 77 ± 9 years; women: 39.6%; weight: 78 ± 15 Kg; height: 171 ± 11 cm). Lone AF and brady- tachy- syndrome were diagnosed in 12.6% of cases. Hypertension and structural heart disease (coronary artery disease, heart failure, valvular heart disease) were responsible of the arrhythmia in 30.6% and 56.8% of patients, respectively. Left ventricular ejection fraction was 60 ± 12%, with a heart rate equal to 78 ± 17 bpm. MMSE and SPPB score were 28 ± 3 and 8.7 ± 2.9. An abnormal GDS score was observed in 19.8% of cases (mean: 3.0 ± 2.7). Interestingly, in univariate analysis, depressive symptoms increased with age (p = 0.002) and the CHA2DS2-VASc score (< =2: 1.3 ± 1.7; 3: 1.9 ± 2.3; 4: 3.9 ± 3.2; 5: 4.0 ± 2.4; > =6: 4.4 ± 2.8; p < 0.001), and were inversely related to MMSE (p = 0.004) and SPPB (p < 0.001). The type of oral anticoagulation (NOACs: 64.0%) did not exert any effect on GDS score (VKA: 3.2 ± 2.2 vs. NOACs: 3.0 ± 3.0; p = 0.717). In multivariate analysis (R = 0.711; p < 0.001), depressive symptoms were higher in those who lived alone (+1.35 ± 0.48; p = 0.007) and were taking a renin-angiotensin system blocker (+0.93 ± 0.43; p = 0.032). Age (-0.07 ± 0.03 per year; p = 0.026), height (-0.09 ± 0.03 per cm; p = 0.001), glomerular filtration rate (-0.03 ± 0.01 per mL/min; p = 0.013) and SPPB (-0.39 ± 0.09 per each point; p < 0.001) were inversely associated with GDS. Conclusions. In a population of elderly patients with persistent AF, the prevalence of depression is not negligible. Importantly, depressive symptoms are significantly associated with the CHA2DS2-VASs score, and, at multivariate analysis, with renal function, to live alone and physical performance. Paradoxically, after adjustment for these factors, GDS score decreases with age per se.