Key result
High-risk ECG markers are linked to ~18% higher risk of incident non-Alzheimer dementia.
Why the study?
It was unknown whether ECG markers are associated with incident non-Alzheimer's dementia and whether they improve risk prediction for non-Alzheimer's dementia.
Do high-risk ECG markers improve the prediction of incident non-Alzheimer's dementia in older primary care patients?
Cohort (n=170,605)
Do high-risk ECG markers improve the prediction of incident non-Alzheimer's dementia in older primary care patients?
Hazard Ratio: 1.18 (95% CI 1.08–1.28)
p-value: p=<0.001
Routine primary care ECGs contain markers that can modestly but significantly improve the prediction of incident non-Alzheimer's dementia in older adults.
May enhance non-Alzheimer dementia risk prediction using routine ECGs in older adults; extends cardiovascular-dementia associations but leaves clinical adoption open.
OBJECTIVES: To determine whether electrocardiogram (ECG) markers are associated with incident non-Alzheimer's dementia (non-AD) and whether these markers also improve risk prediction for non-AD. MATERIALS AND METHODS: We retrospectively included 170,605 primary care patients aged 60 years or older referred for an ECG by their general practitioner and followed them for a median of 7.6 years. Using Cox regression, we reported hazard ratios (HRs) for electrocardiogram markers. Subsequently, we evaluated if addition of these electrocardiogram markers to a clinical model improved risk prediction for non-AD using change in area under the receiver-operator characteristics curve (AUC). RESULTS: The 5-year cumulative incidence of non-AD was 3.4 %. Increased heart rate (HR=1.06 pr. 10 bpm [95% confidence interval: 1.04-1.08], p<0.001), shorter QRS duration (HR=1.07 pr. 10 ms [1.05-1.09], p<0.001), elevated J-amplitude (HR=1.16 pr. mm [1.08-1.24], p<0.001), decreased T-peak amplitude (HR=1.02 pr. mm [1.01-1.04], p=0.002), and increased QTc (HR=1.08 pr. 20 ms [1.05-1.10], p<0.001) were associated with an increased rate of non-AD. Atrial fibrillation on the ECG (HR=1.18 [1.08-1.28], p<0.001) Sokolow-Lyon index > 35 mm (HR=1.31 [1.18-1.46], p<0.001) and borderline (HR=1.18 [1.11-1.26], p<0.001) or abnormal (HR=1.40 [1.27-1.55], p<0.001) QRS-T angle were also associated with an increased rate of non-AD. Upon addition of ECG markers to the Cox model, 5-year and 10-year C-statistic (AUC) improved significantly (delta-AUC, 0.36 [0.18-0.50] and 0.20 [0.03-0.35] %-points, respectively). CONCLUSIONS: ECG markers typical of an elevated cardiovascular risk profile were associated with non-AD and improved both 5-year and 10-year risk predictions for non-AD.
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Isaksen et al. (2022) conducted a cohort in Elevated cardiovascular risk profile in primary care patients (n=170,605). High-risk electrocardiogram (ECG) markers vs. Normal or reference electrocardiogram markers was evaluated on Incident non-Alzheimer's dementia (associated with atrial fibrillation on ECG) (HR 1.18, 95% CI 1.08-1.28, p=<0.001). ECG markers typical of an elevated cardiovascular risk profile (e.g., atrial fibrillation, left ventricular hypertrophy, and prolonged QTc) were associated with increased incident non-Alzheimer dementia and improved risk predictions.
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