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| 1 | Self-reported risk of stroke and factors associated with underestimation of stroke risk among older adults with atrial fibrillation: the SAGE-AF study显示文摘Background Though engaging patients with atrial fibrillation(AF) in understanding their stroke risk is encouraged by guidelines, little is known regarding AF patients' perceived stroke risk or its relationship with oral anticoagulation(OAC) use. We aim to identify factors associated with underestimation of stroke risk among older patients with AF and relate this to OAC use. Methods Data are from the ongoing SAGE(Systematic Assessment of Geriatric Elements)-AF study, which included older patients(> 65 years) with non-valvular AF and a CHA2 DS2-VASc score of ≥ 2. Participants reported their perceived risk of having a stroke without OAC. We compared the perceived risk to CHA2 DS2-VASc predicted stroke risk and classified participants as 'over' or 'under' estimators, and identified factors associated with underestimation of risk using multiple logistic regression. Results The average CHA2 DS2-VASc score of 915 participants(average age: 75 years, 47% female, 86% white) was 4.3 ± 1.6, 43% of participants had discordant predicted and self-reported stroke risks. Among the 376 participants at highest risk(CHA2 DS2-VASc score ≥ 5), 46% of participants underestimated their risk. Older participants(≥ 85 years) were more likely and OAC treated patients less likely to underestimate their risk of developing a future stroke than respective comparison groups. Conclusions A significant proportion of study participants misperceived their stroke risk, mostly by overestimating. Almost half of participants at high risk of stroke underestimated their risk, with older patients more likely to do so. Patients on OAC were less likely to underestimate their risk, suggesting that successful efforts to educate patients about their stroke risk may influence treatment choices. | Jordy Mehawej Jane Saczynski Jerry H.Gurwitz Hawa O.Abu Benita A.Bamgbade Wei-Jia WANG Tenes Paul Katherine Trymbulak Connor Saleeba Zi-Yue WANG Catarina I.Kiefe Robert J.Goldberg David D.Mc Manus | 2020 | Journal of Geriatric Cardiology2020，17，8： | 2 |
| 2 | Incident frailty and cognitive impairment by heart failure status in older patients with atrial fibrillation: the SAGE-AF study显示文摘Background Atrial fibrillation(AF) and heart failure(HF) frequently co-occur in older individuals. Among patients with AF, HF increases risks for stroke and death, but the associations between HF and incident cognition and physical impairment remain unknown. We aimed to examine the cross-sectional and prospective associations between HF, cognition, and frailty among older patients with AF. Methods The SAGE-AF(Systematic Assessment of Geriatric Elements in AF) study enrolled 1244 patients with AF(mean age 76 years, 48% women) from five practices in Massachusetts and Georgia. HF at baseline was identified from electronic health records using ICD-9/10 codes. At baseline and 1-year, frailty was assessed by Cardiovascular Health Survey score and cognition was assessed by the Montreal Cognitive Assessment. Results Patients with prevalent HF(n = 463, 37.2%) were older, less likely to be non-Hispanic white, had less education, and had greater cardiovascular comorbidity burden and higher CHA2 DS2 VASC and HAS-BLED scores than patients without HF(all P's < 0.01). In multivariable adjusted regression models, HF(present vs. absent) was associated with both prevalent frailty(adjusted odds ratio [a OR]: 2.38, 95% confidence interval [CI]: 1.64-3.46) and incident frailty at 1 year(a OR: 2.48, 95% CI: 1.37-4.51). HF was also independently associated with baseline cognitive impairment(a OR: 1.60, 95% CI: 1.22-2.11), but not with developing cognitive impairment at 1 year(a OR 1.04, 95%CI: 0.64-1.70). Conclusions Among ambulatory older patients with AF, the co-existence of HF identifies individuals with physical and cognitive impairments who are at higher short-term risk for becoming frail. Preventive strategies to this vulnerable subgroup merit consideration. | Wei-Jia WANG Darleen Lessard Jane Saczynski Robert J Goldberg Alan S.Go Tenes Paul Ely Gracia David D McManus | 2020 | Journal of Geriatric Cardiology2020，17，11： | 2 |
| 3 | Hearing loss and cognitive decline among older adults with atrial fibrillation:the SAGE-AF study显示文摘Objective To examine the association between hearing loss and cognitive function cross-sectionally and prospectively among older adults with atrial fibrillation(AF).Methods Patients with AF≥65-year-old(n=1244)in the SAGE(Systematic Assessment of Geriatric Elements)-AF study were recruited from five internal medicine or cardiology clinics in Massachusetts and Georgia.Hearing was assessed by a structured questionnaire at baseline.Cognitive function was assessed by Montreal Cognitive Assessment(MoCA)at baseline and one year.Cognitive impairment was defined as score≤23 on the MoCA.The associations between hearing loss and cognitive function were examined by multivariable adjusted logistic regression.Results Participants with hearing loss(n=451,36%)were older,more likely to be male,and have depressive symptoms than patients without hearing loss.At baseline,528(42%)participants were cognitively impaired.Individuals with hearing loss were significantly more likely to have cognitive impairment at baseline[adjusted odds ratio(OR)=1.37,95%confidence interval(CI):1.05–1.81].Among the 662 participants who did not have cognitive impairment at baseline and attended the one-year follow-up visit,106(16%)developed incident cognitive impairment.Individuals with,versus those without,hearing loss were significantly more likely to develop incident cognitive impairment at one year(adjusted OR=1.68,95%CI:1.07–2.64).Conclusions Hearing loss is a prevalent but under-recognized factor associated with cognitive impairment in patients with AF.Assessment for hearing loss may be indicated among these patients to identify individuals at high-risk for adverse outcomes. | Wei-Jia WANG Darleen Lessard Hawa Abu David D.McManus Tanya Mailhot Jerry H.Gurwitz Robert J.Goldberg Jane Saczynski | 2020 | Journal of Geriatric Cardiology2020，17，4： | 1 |
| 4 | Cognitive trajectories after postoperative delirium显示文摘 | Jane S Saczynski Edward R Marcantonio Lien Quach | 2012 | N Engl J Med2012，367，1： | 1 |
| 5 | Delirium in elderly people显示文摘 | Sharon K Inouye Rudi GJ Westendorp Jane S Saczynski | 2014 | The Lancet . 2014 (9920)2014，，9920： | 1 |
| 6 | Cerebral Infarcts and Cognitive Performance: Importance of Location and Number of Infarcts显示文摘 | Jane S. Saczynski Sigurdur Sigurdsson Maria K. Jonsdottir Gudny Eiriksdottir Palmi V. Jonsson Melissa E. Garcia Olafur Kjartansson Oscar Lopez Mark A. van Buchem Vilmunder Gudnason Lenore J. Launer | 2009 | Stroke2009，，3： | 1 |
| 7 | Health behavior outcomes in stroke survivors prescribed wearables for atrial fibrillation detection stratified by age显示文摘BACKGROUND Smartwatches have become readily accessible tools for detecting atrial fibrillation(AF).There remains limited data on how they affect psychosocial outcomes and engagement in older adults.We examine the health behavior outcomes of stroke survivors prescribed smartwatches for AF detection stratified by age.METHODS We analyzed data from the Pulsewatch study,a randomized controlled trial that enrolled patients(≥50 years)with a history of stroke or transient ischemic attack and CHA2DS2-VASc≥2.Intervention participants were equipped with a cardiac patch monitor and a smartwatch-app dyad,while control participants wore the cardiac patch monitor for up to 44 days.We evaluated health behavior parameters using standardized tools,including the Consumer Health Activation Index,the Generalized Anxiety Disorder questionnaire,the 12-Item Short Form Health Survey,and wear time of participants categorized into three age groups:Group 1(ages 50-60),Group 2(ages 61-69),and Group 3(ages 70-87).We performed statistical analysis using a mixedeffects repeated measures linear regression model to examine differences amongst age groups.RESULTS Comparative analysis between Groups 1,2 and 3 revealed no significant differences in anxiety,patient activation,perception of physical health and wear time.The use of smartwatch technology was associated with a decrease in perception of mental health for Group 2 compared to Group 1(β=-3.29,P=0.046).CONCLUSION Stroke survivors demonstrated a willingness to use smartwatches for AF monitoring.Importantly,among these study participants,the majority did not experience negative health behavior outcomes or decreased engagement as age increased. | Joanne Mathew Jordy Mehawej Ziyue Wang Taylor Orwig Eric Ding Andreas Filippaios Syed Naeem Edith Mensah Otabil Alex Hamel Kamran Noorishirazi IrinaRadu Jane Saczynski David D.McManus Khanh-Van Tran | 2024 | Journal of Geriatric Cardiology2024，21，3： | 0 |
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