Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(6), 656–662. https://doi.org/10.1002/clc.24006 Dr. Riccardo Proietti et al.
Points
- Atrial fibrillation (AF) patients with vascular dementia have a higher risk of intracranial hemorrhages (ICH) compared to those with Alzheimer’s disease (AD).
- AF patients with vascular dementia also face a higher risk of ischemic stroke/transient ischemic attack (TIA), hospitalizations, and mortality than patients with AD.
- The study involved a cohort of 2,377 AF patients with dementia, with 1,225 having vascular dementia and 1,152 having AD.
- Propensity score matching (PSM) was used to create balanced cohorts, resulting in 615 patients in each group.
- These findings emphasize the importance of considering the specific type of dementia in AF patients for prognosis assessment and management.
Summary
Atrial fibrillation (AF) has been linked to an increased risk of Alzheimer’s disease (AD) and vascular dementia, but the clinical implications of this association have received limited attention. In this cohort study conducted between January 2000 and 2017, the researchers aimed to explore the relationship between AD or vascular dementia and adverse outcomes in AF patients.
The study identified 2,377 AF patients with dementia, including 1,225 with vascular dementia and 1,152 with AD. To ensure a balanced comparison, propensity score matching (PSM) was employed, resulting in 615 patients in each cohort. After PSM, all variables were well-matched between the two groups. The researchers recorded incident intracranial hemorrhages (ICH), the composite of ischemic stroke/transient ischemic attack (TIA), hospitalizations, and all-cause deaths during the four-year follow-up period.
Following PSM, it was found that AF patients with vascular dementia had a higher incidence of ICH during the follow-up period compared to those with AD. The hazard ratio (HR) for incident ICH was 2.22 (95% confidence interval [CI]: 1.33−3.70, log-rank p = 0.002) in patients with vascular dementia. Moreover, patients with vascular dementia also exhibited a 1.32-fold higher risk of ischemic stroke/TIA (HR: 1.32, 95% CI: 1.09−1.59, log-rank p = 0.003) than those with AD. Additionally, AF patients with vascular dementia had a higher risk of rehospitalization (HR: 1.14, 95% CI: 1.01−1.31) and mortality (HR: 1.25, 95% CI: 1.01−1.58) than those with AD.
In conclusion, this research highlights distinct prognoses associated with different forms of dementia in AF patients. AD is linked to a higher risk of ICH, while vascular dementia is associated with a higher risk of stroke/TIA, hospitalization, and mortality. These findings underscore the importance of considering the specific type of dementia when assessing the prognosis and management of AF patients.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24006
References Proietti, R., Rivera‐Caravaca, J. M., López‐Gálvez, R., Harrison, S. L., Buckley, B. J. R., Marín, F., Underhill, P., Shantsila, E., Shantsila, A., Davies, R., Lane, D. A., & Lip, G. Y. H. (2023). Clinical implications of different types of dementia in patients with atrial fibrillation: Insights from a global federated health network analysis. Clinical Cardiology, 46(6), 656–662. https://doi.org/10.1002/clc.24006
