Prevalence and patterns of cognitive impairment in acute coronary syndrome patients: A systematic review

Abstract

Background Minimising risk factors through secondary prevention behaviour is challenging for patients following an acute coronary syndrome. Cognitive impairment can potentially make these changes more difficult. However, cognitive impairment prevalence in acute coronary syndrome patients is poorly understood. Design This study was based on a systematic review. Methods A systematic review was conducted of PubMed, Medline, PsycINFO and Cochrane databases up to March 2019, to identify studies reporting the prevalence of cognitive impairment in acute coronary syndrome patients. Predefined inclusion criteria were specified, including use of a validated cognitive impairment screening tool. Studies were excluded if patients had diagnosed dementia or coronary artery bypass graft surgery. Strengthening The Reporting of Observational Studies in Epidemiology and Cochrane Risk of Bias tools were used to assess quality. Results From 747 potential studies, nine were included. The total sample size was 6457 (range 53–2174), mean age range was 51.3–77.4 years, and range of proportions of males was 57–100%. Reported cognitive impairment prevalence rates varied substantially (9–85%) with no clear pattern over time. From the two studies which examined domains, verbal fluency, memory and language were affected the most. Meta-analysis could not be undertaken due to diverse screening tools ( n = 9), cut-off scores and screening timepoints. Conclusions Cognitive impairment in acute coronary syndrome patients is currently poorly described, and likely affects a substantial number of acute coronary syndrome patients who remain undetected and have the potential to develop to dementia in the future. As domains are most affected, this could impact understanding and retention of health education. Research is needed to accurately determine the prevalence of cognitive impairment in acute coronary syndrome patients and create suitable standardised measures and thresholds.

Long-Term Prognostic Value of Cognitive Impairment on Top of Frailty in Older Adults after Acute Coronary Syndrome

“…In a recent systematic review, it ranged from 9 to 85%, ref. [9] with our results (15% mild impairment, 12% moderate to severe impairment) falling in the mid-range. The discrepancy between studies can be explained by different patient characteristics and tests used for cognition assessment.…”

“…Few studies have evaluated cognitive impairment in patients with acute coronary syndrome [4][5][6][7][8]. In a recent systematic review, the reported prevalence rates varied substantially (9-85%) [9]. On the other hand, most studies have focused mainly on short-term outcomes.…”

Cognitive status and rehabilitation outcomes of patients in acute rehabilitation post Covid-19

“…Moreover, while our findings are like those found in stroke patients, they differ from those found in other rehabilitation populations, including patients who suffered acute coronary syndrome (ACS). Compared to our population, patients with ACS demonstrate cognitive impairments to a lesser extent and only in the language and memory domains, not in executive function or attention 37–39 .…”

A Review of Acute Coronary Syndrome and its Potential Impact on Cognitive Function

“…A recently published systematic review noted that the overall CI prevalence rate post-ACS is between 9 and 85% in both the short and the long-term [42]. Such a wide range of values may result from the lack of clear definition of CI as well as from the heterogeneity of the conducted studies, which have used various cognitive screening tools with diverse levels of sensitivity and cut-off scores and diverse timepoints measured.…”