Key result
Rhythm control is linked to ~14% lower dementia risk vs rate control in anticoagulated AF.
Why the study?
Atrial fibrillation increases dementia risk and catheter ablation may lower it, but the association of a rhythm-control strategy versus rate control with dementia risk remained unclear.
Does a rhythm-control strategy reduce the risk of all-cause dementia in anticoagulated patients with atrial fibrillation compared to a rate-control strategy?
Cohort (n=41,135)
Does a rhythm-control strategy reduce the risk of all-cause dementia in anticoagulated patients with atrial fibrillation compared to a rate-control strategy?
Effect estimate: sHR 0.86 (95% CI 0.80-0.93)
Absolute Event Rate: 21.2% vs 25.2%
In anticoagulated patients with atrial fibrillation, a rhythm-control strategy is associated with a significantly lower risk of incident dementia compared to a rate-control strategy.
Rhythm control was associated with lower dementia risk in anticoagulated AF; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Atrial fibrillation (AF) increases the risk of dementia, and catheter ablation of AF may be associated with a lower risk of dementia. We investigated the association of a rhythm-control strategy for AF with the risk of dementia, compared with a rate-control strategy. METHODS: This population-based cohort study included 41,135 patients with AF on anticoagulation who were newly treated with rhythm-control (anti-arrhythmic drugs or ablation) or rate-control strategies between 1 January 2005 and 31 December 2015 from the Korean National Health Insurance Service database. The primary outcome was all-cause dementia, which was compared using propensity score overlap weighting. RESULTS: In the study population (46.7% female; median age: 68 years), a total of 4,039 patients were diagnosed with dementia during a median follow-up of 51.7 months. Rhythm control, compared with rate control, was associated with decreased dementia risk (weighted incidence rate: 21.2 versus 25.2 per 1,000 person-years; subdistribution hazard ratio [sHR] 0.86, 95% confidence interval [CI] 0.80-0.93). The associations between rhythm control and decreased dementia risk were consistently observed even after censoring for incident stroke (sHR 0.89, 95% CI 0.82-0.97) and were more pronounced in relatively younger patients and those with lower CHA2DS2-VASc scores. Among dementia subtypes, rhythm control was associated with a lower risk of Alzheimer's disease (sHR 0.86, 95% CI 0.79-0.95). CONCLUSIONS: Among anticoagulated patients with AF, rhythm control was associated with a lower risk of dementia, compared with rate control. Initiating rhythm control in AF patients with fewer stroke risk factors might help prevent subsequent dementia.
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Kim et al. (2021) conducted a cohort in Atrial fibrillation (n=41,135). Rhythm-control strategy vs. Rate-control strategy was evaluated on All-cause dementia (sHR 0.86, 95% CI 0.80-0.93). Rhythm control, compared with rate control, was associated with a decreased risk of all-cause dementia (sHR 0.86; 95% CI 0.80-0.93) among anticoagulated patients with atrial fibrillation.
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