Depressive symptoms in older patients undergoing electrical cardioversion of persistent atrial fibrillation. A possible association with clinical complexity, physical performance and inflammation.

Abstract

Atrial fibrillation (AF) is frequently diagnosed in older subjects, being often associated with frailty. In AF patients, depression is important, increasing mortality when heart failure is present, reducing adherence to therapy, and contributing to dementia development. Aim of this study was to identify the variables associated with depressive symptoms in older subjects with persistent AF. All consecutive patients undergoing electrical cardioversion of the arrhythmia were enrolled and evaluated with the Comprehensive Geriatric Assessment (CGA). In particular, the Mini-Mental State Examination (MMSE) explored neurocognitive profile, the Geriatric Depression Scale (15-item version; GDS) depressive symptoms, and the Short Physical Performance Battery (SPPB) physical performance. Interleukine-6 (IL-6) levels were determined with ELISA kits. Overall, 258 patients were enrolled (age: 78±8 years; women: 41.1%; CHA₂DS₂-VA: 3.5±1.4). Hypertension was highly prevalent (81.8%); left ventricular ejection fraction was normal (58±12%), and heart rate adequately controlled (80±17 bpm). MMSE, GDS and SPPB were, respectively, 27.9±2.5, 3.3±2.9 and 8.7±2.7. IL-6 concentration, available in 59.3% of patients, was 4.3±3.5 pg/mL. A multivariate analysis model showed that depressive symptoms were directly associated with CHA₂DS₂-VA (p=0.019), and negatively with SPPB (p<0.001). When IL-6 was available, the correlation with SPPB persisted (p<0.001), the link with CHA₂DS₂-VA disappeared (p=0.147), and was replaced by that with cytokine levels (p=0.011). Depressive symptoms in older AF patients are related to clinical complexity and to physical performance. IL-6, expression of chronic inflammation, has a significant association with GDS. These findings confirm that AF is a marker of cardiovascular aging and frailty.