UMMS Affiliation

Division of Cardiovascular Medicine, Department of Medicine

Publication Date


Document Type



Cardiology | Cardiovascular Diseases | Epidemiology | Geriatrics | Health Services Administration | Mental and Social Health | Psychiatry and Psychology | Psychological Phenomena and Processes


BACKGROUND: Depression, anxiety, and cognitive impairments occur in up to 40 % of adults with AF and are associated with poorer health-related quality of life (HRQoL) and higher symptom burden. However, it is unknown how often these impairments co-occur, or multimorbidity, and how multimorbidity effects HRQoL and symptom burden.

METHODS: Patients with AF age > /=65 years with a CHA2DS2VASC risk score > /= 2 and eligible for oral anticoagulation therapy were recruited from five clinics in a prospective cohort study. Participants completed validated measures of depression (PHQ9) and anxiety (GAD7), cognitive impairment (MoCA), and HRQOL and AF symptom burden (AFEQT). Multinomial logistic regression was used.

RESULTS: Participants (N = 1244, 49 % female) were on average 76 +/- 7 years; 86 % were non-Hispanic white. Approximately 35 % of participants had 1 impairment, 17 % had 2 impairments and 8% had 3 impairments; 39 % had none of the 3 impairments examined. Compared to participants with no impairments, patients with 1, 2 and 3 impairments had higher odds of poor HRQoL (adjusted OR [AOR] = 1.77, 95 % CI 1.21, 2.60; AOR = 6.64, 95 % CI 4.43, 9.96; and AOR = 7.50, 95 % CI 4.40, 12.77, respectively) and those with 2 and 3 impairments had higher odds of high symptom burden (AOR = 3.69 95 % CI 2.22, 6.13; and AOR = 5.41 95 % CI 2.85, 10.26).

CONCLUSIONS: Psychosocial/cognitive multimorbidity is common among older adults with AF and is associated with poor HRQoL and high symptom burden. Clinicians might consider incorporating psychosocial and cognitive screens into routine care as this may identify a high-risk population.


Cognitive impairment, Health-Related quality of life, Multimorbidity, Psychosocial, Symptom burden

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© 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (

DOI of Published Version



Bamgbade BA, Sanghai SR, McManus DD, Lessard D, Waring ME, Forrester S, Pierre-Louis I, Saczynski JS. Psychosocial and cognitive multimorbidity and health-related quality of life and symptom burden in older adults with atrial fibrillation: The systematic assessment of geriatric elements in atrial fibrillation (SAGE-AF) cohort study. Arch Gerontol Geriatr. 2020 May 28;90:104117. doi: 10.1016/j.archger.2020.104117. Epub ahead of print. PMID: 32474170. Link to article on publisher's site

Journal/Book/Conference Title

Archives of gerontology and geriatrics

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Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.