Article Impact Level: HIGH Data Quality: STRONG Summary of Nature Medicine, 1–7. https://doi.org/10.1038/s41591-024-03049-9 Dr. Alastair Mobley et al.
Points
- A population-based cohort study used electronic healthcare records from over 5 million UK primary care patients (2005-2020) to examine the association between atrial fibrillation (AF) and thromboembolic outcomes, including vascular dementia.
- Among 290,525 AF patients aged 40-75, 36,340 had no history of stroke, low stroke risk, and no oral anticoagulant prescription. These patients were matched with 117,298 controls without AF based on age, sex, and region.
- Over a median follow-up of 5 years, incident stroke occurred in 3.8% of AF patients compared to 1.5% of controls, with AF patients showing adjusted hazard ratios of 2.06 for stroke, 2.39 for arterial thromboembolism, and 1.44 for all-cause mortality.
- AF was associated with a higher risk of all-cause dementia (HR 1.17) and vascular dementia (HR 1.68), but no significant association was found with Alzheimer’s disease.
- The findings highlight the need to consider outcomes beyond conventional stroke risk factors in AF management, emphasizing the significant impact of AF on vascular dementia and overall mortality.
Summary
In a population-based cohort study utilizing electronic healthcare records from over 5 million primary care patients in the UK from 2005 to 2020, the association between atrial fibrillation (AF) and thromboembolic outcomes, including vascular dementia, was investigated. Among the 290,525 patients diagnosed with AF aged 40-75 years, 36,340 had no history of stroke, a low perceived stroke risk, and no oral anticoagulant prescription. Matching these AF patients with 117,298 controls without AF based on age, sex, and region, the study found that over a median follow-up of 5 years, incident stroke occurred in 3.8% of AF patients compared to 1.5% of controls, with adjusted hazard ratios (HR) of 2.06 for stroke, 2.39 for arterial thromboembolism, and 1.44 for all-cause mortality, all statistically significant.
The results indicated a substantial increase in thromboembolic outcomes and mortality in AF patients despite the absence of conventional stroke risk factors. Notably, AF was associated with a higher risk of all-cause dementia, particularly vascular dementia, with a hazard ratio of 1.17 for all-cause dementia and 1.68 for vascular dementia. In contrast, the study did not find a significant association between AF and Alzheimer’s disease. These findings underscore the importance of considering outcomes beyond stroke risk factors in the prevention and management of thromboembolism in patients with AF, highlighting the significant impact of AF on vascular dementia and mortality outcomes.
Link to the article: https://www.nature.com/articles/s41591-024-03049-9
References Mobley, A. R., Subramanian, A., Champsi, A., Wang, X., Myles, P., McGreavy, P., Bunting, K. V., Shukla, D., Nirantharakumar, K., & Kotecha, D. (2024). Thromboembolic events and vascular dementia in patients with atrial fibrillation and low apparent stroke risk. Nature Medicine, 1–7. https://doi.org/10.1038/s41591-024-03049-9
