Evidence map›Paper›PMID 23460057›Full record

SynthesisAnnals of internal medicine2013

Cognitive impairment associated with atrial fibrillation: a meta-analysis.

Shadi Kalantarian, Theodore A Stern, Moussa Mansour, Jeremy N Ruskin

Registry-linked trialAbstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Annals of internal medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04033510 (Acute Cognitive Changes During Atrial Fibrillation Episodes), which is not on this map. Cited by 201 papers, 16 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
201citing papers in PubMed, 16 pooled it
16.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04033510 active not recruitingnot on this mapstarted 2019, after this paper: background citation

Acute Cognitive Changes During Atrial Fibrillation Episodes (AFCOG)

TypeobservationalSponsorDavid Brunk, PA-C, MMSRan2019 to 2027Enrolled600ConditionsAtrial Fibrillation, Cognitive Symptom, Executive Dysfunction, Cognitive ChangeArmsStandard of Care Interventions to convert patient from atrial fibrillation to normal rhythm
3 · Its place in the literature

Who cites it

201 citing papers in PubMed, 16 syntheses or guidelines pooled it, 408 citations in OpenAlex.

  1. Beyond the beats: a systematic review of the underlying inflammatory pathways between atrial fibrillation and cognitive decline.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
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  4. Predictive role of atrial fibrillation in cognitive decline: a systematic review and meta-analysis of 2.8 million individuals.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2022
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  20. Cognition in Cardiovascular Disease.Current neurology and neuroscience reports · 2026
    Review

141 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 1 institution in 1 country.

Shadi KalantarianCardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, GRB 109, Boston, MA 02114, USA.
Theodore A Stern
Moussa Mansour
Jeremy N Ruskin
Massachusetts General Hospital · US

Funding

HARVARD CLINICAL AND TRANSLATIONAL SCIENCE CENTER (UL1)UL1RR025758 · NCRR · HARVARD MEDICAL SCHOOL · PI NADLER, LEE MARSHALL · 2008 to 2011
$91.4M
NCRR NIH HHS UL1 RR 025758NCRR NIH HHS UL1 RR025758
6 · The paper itself

Abstract

backgroundAtrial fibrillation (AF) has been linked with an increased risk for cognitive impairment and dementia. PURPOSE: To complete a meta-analysis of studies examining the association between AF and cognitive impairment. DATA SOURCES: Search of MEDLINE, PsycINFO, Cochrane Library, CINAHL, and EMBASE databases and hand search of article references. STUDY SELECTION: Prospective and nonprospective studies reporting adjusted risk estimates for the association between AF and cognitive impairment. DATA EXTRACTION: Two abstracters independently extracted data on study characteristics, risk estimates, methods of AF and outcome ascertainment, and methodological quality. DATA SYNTHESIS: Twenty-one studies were included in the meta-analysis. Atrial fibrillation was significantly associated with a higher risk for cognitive impairment in patients with first-ever or recurrent stroke (relative risk [RR], 2.70 [95% CI, 1.82 to 4.00]) and in a broader population including patients with or without a history of stroke (RR, 1.40 [CI, 1.19 to 1.64]). The association in the latter group remained significant independent proof of clinical stroke history (RR, 1.34 [CI, 1.13 to 1.58]). However, there was significant heterogeneity among studies of the broader population (I2 = 69.4%). Limiting the analysis to prospective studies yielded similar results (RR, 1.36 [CI, 1.12 to 1.65]). Restricting the analysis to studies of dementia eliminated the significant heterogeneity (P = 0.137) but did not alter the pooled estimate substantially (RR, 1.38 [CI, 1.22 to 1.56]). LIMITATIONS: There is an inherent bias because of confounding variables in observational studies. There was significant heterogeneity among included studies.

conclusionEvidence suggests that AF is associated with a higher risk for cognitive impairment and dementia, with or without a history of clinical stroke. Further studies are required to elucidate the association between AF and subtypes of dementia as well as the cause of cognitive impairment.

Indexed as

Atrial FibrillationCognition DisordersDementiaHumansPublication BiasRecurrenceRisk FactorsSensitivity and SpecificityStroke

Identifiers

PMID23460057
PMCPMC4465526
OpenAlexW1978219366

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.