Risk of Incident Atrial Fibrillation and Subsequent Use of Oral Anticoagulants in Patients with Dementia

Abstract

Background: Dementia and atrial fibrillation (AF) have many shared risk factors. There are limited data on the risks of incident AF and AF-related clinical outcomes in patients with dementia. Methods: Out study utilized the Taiwan National Health Insurance Research Database. A total of 544,074 patients with dementia were compared to 554,074 age- and sex-matched patients without dementia regarding the risk of incident AF. Among patients with dementia who experienced incident AF, the risks of clinical events of patients treated with warfarin or NOACs were compared to those without OACs. Results: The risk of incident AF was greater for patients with dementia compared to those without (1.89 vs 1.78 per 100 person-years). Among patients with dementia and experienced incident AF, warfarin use was associated with a higher risk of ischemic stroke (aHR 1.290; 95%CI 1.156-1.440), intracranial hemorrhage (ICH)(aHR 1.678; 95%CI 1.346-2.090) and major bleeding (aHR 1.192; 95%CI 1.073-1.323) compared to non-OACs. NOAC use was associated with a lower risk of ischemic stroke (aHR 0.421; 95%CI 0.352-0.503) and composite risk of ischemic stroke or major bleeding (aHR 0.544; 95%CI 0.487-0.608) compared to non-OACs. These results were consistent among the patients after the propensity matching. Conclusions: In this nationwide cohort, the risk of incident AF was higher in patients with dementia. For patients with dementia who experienced incident AF, NOAC use was associated with better clinical outcomes compared to non-OAC. Patients with dementia require a holistic approach to their care and management, including the use of NOACs to reduce risks of clinical events.

Atrial Fibrillation Burden: Impact on Stroke Risk and Beyond

“…Evidence suggests that anticoagulation may protect against or slow the progression of cognitive impairment by reducing silent brain infarctions or microemboli; rhythm control strategies may also be useful in this regard [60]. In the previously mentioned study by Tsai et al, for patients with dementia who experienced new-onset AF, NOAC use was associated with a better clinical outcome compared with no anticoagulation [59]. This is important, as patient with cognitive impairment may be less able to report symptoms of AF or be less considered for NOAC use by treating physicians due to a perceived lower AF burden.…”

“…In addition, recent evidence suggests that AF and cognitive impairment may be downstream events of atrial cardiomyopathy, which is in turn caused by metabolic syndrome and obesity, suggesting that cardiovascular and metabolic comorbidities may be mediators of the association between AF and cognitive impairment [58]. Tsai and colleagues also found that patients with dementia compared to patients without dementia had a higher risk of incident AF, suggesting a possible bidirectional relationship [59]. Evidence suggests that anticoagulation may protect against or slow the progression of cognitive impairment by reducing silent brain infarctions or microemboli; rhythm control strategies may also be useful in this regard [60].…”

“…Medicina 2024, 60, x FOR PEER REVIEW 6 of 14 experienced new-onset AF, NOAC use was associated with a better clinical outcome compared with no anticoagulation [59]. This is important, as patient with cognitive impairment may be less able to report symptoms of AF or be less considered for NOAC use by treating physicians due to a perceived lower AF burden.…”