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Risk of Dementia in Stroke-Free Patients With Atrial Fibrillation
Study Questions:
What is the association between incident atrial fibrillation (AF) and developing dementia in elderly patients without a history of stroke?
Methods:
The authors used a South Korean national health insurance database to identify patients between 2005 and 2012, who were >60 years old and developed nonvalvular AF. Patients with a history of stroke, dementia, pre-existing AF, and valvular heart disease were excluded. Cognition was assessed using a Korean Dementia Screening Questionnaire, which has been validated in this population. Propensity scores were used to account for differences between patients who did and did not develop AF in a 1:2 ratio. Cox proportional hazard regression models were used to evaluate the association between incident AF and incident dementia. Analyses were adjusted for relevant clinical variables.
Results:
There were 262,611 patients included in the study and 10,435 developed AF. Patients who developed AF were older and more likely to be female, have hypertension, and heart failure than patients who did not develop AF. There was no difference in baseline cognitive function between patients who developed AF and those who did not. After propensity-score matching, baseline characteristics between the patients were similar.
Dementia occurred in 24.4% of the patients who developed AF and in 14.4% of the patients who did not develop AF (hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.54-1.72). After propensity-score matching, the risk of dementia was still higher in patients who had incident AF (HR, 1.52; 95% CI, 1.43-1.63). Stroke was more common in the cohort with incident AF: 20% versus 4%. After censoring patients who had a stroke, patients with incident AF were still more likely to develop dementia (HR, 1.37; 95% CI, 1.28-1.47; and in the propensity-matched analysis HR, 1.27; 95% CI, 1.18-1.37). In patients with AF, those who were taking oral anticoagulation had a lower risk of developing dementia (HR, 0.61; 95% CI, 0.54-0.68).
Conclusions:
In this elderly population, incident AF was associated with a higher risk of developing dementia, and oral anticoagulation attenuated this risk.
Perspective:
AF is common and prior research has shown a possible association between AF and dementia. This study is unique in that the authors were able to evaluate the association between incident AF, rather than AF prevalence, and the development of dementia using a national health insurance database. Incident AF increased the risk of dementia, even when patients who had a stroke during the study were excluded from analyses. Use of oral anticoagulation decreased the risk of dementia in patients with AF.
This study builds on prior work, strengthening the association between AF and dementia. It is limited because it uses administrative data, and unaccounted confounders may be present. Additional data are needed before routinely recommending oral anticoagulation to reduce the risk of dementia in patients with low risk of stroke; however, this research supports the notion that cognitive function should be monitored in patients with AF because they are at risk of developing dementia.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Sleep Apnea
Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Cognition, Dementia, Heart Failure, Risk, Secondary Prevention, Stroke, Vascular Diseases
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