The Impact of Atrial Fibrillation on Physical Performance in Older Adults: A Longitudinal Study in Relation to Cognitive Function

Objectives: Atrial fibrillation (AF), the most common arrhythmia in older adults, affects quality of life and physical performance. However, evidence is limited, and the impact of cognitive decline and frailty remains unclear. The objective of this study was to evaluate the long-term effects of AF on physical performance in older adults, considering cognitive function, frailty, and sex differences. Design: Observational cohort study. Setting and Participants: Individuals aged ≥65 years in residential and institutional settings. Methods: We collected sociodemographic, clinical, functional, frailty, and cognitive data. Participants were categorized by cognitive function [Mini-Mental State Examination (MMSE) ≥24 or <24] and assessed for physical performance (muscle strength, walking speed, and sit-to-stand) and AF at baseline and after 4.4 years. The relationship between AF and physical performance, stratified by cognitive function and sex, was examined using regression and mixed linear models. Results: Among 2104 participants, 149 had AF at baseline. Although individuals with AF showed worse gait speed and sit-to-stand performance, these differences were not significant after adjusting for covariates and cognitive status. Over time, AF was linked to a steeper decline in handgrip strength and gait speed in participants with MMSE <24 (β = −0.05 kg/year; 95% CI, −0.09 to −0.003; P = .03 and β = −0.14 m/s per year; 95% CI, −0.23 to −0.06; P = .001), particularly in females. In those with MMSE ≥24, only walking speed declined significantly in participants with AF (β = −0.07 m/s per year; 95% CI, −0.12 to −0.01; P = .02), with a similar trend in males. These results remained significant after adjusting for frailty. Conclusions and Implications: AF impacts physical performance, notably walking speed and handgrip strength, varying by cognitive decline and sex. Multidisciplinary interventions, including optimized AF management and geriatric care strategies, are crucial for preserving motor abilities and quality of life in older adults.