May 21, 2021International Journal of Geriatric PsychiatryOpen Access

Risk of dementia in patients with atrial fibrillation: Short versus long follow‐up. A systematic review and meta‐analysis

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Why the study?

No previous meta-analyses had compared the risk of dementia due to underlying AF in the short-term versus the long-term period.

Does atrial fibrillation increase the risk of dementia and Alzheimer's disease over short versus long follow-up periods?

Structured PICO

Does atrial fibrillation increase the risk of dementia and Alzheimer's disease over short versus long follow-up periods?

Population

18 studies involving 3,559,349 subjects

Intervention

Atrial fibrillation (exposure)

Comparator

Subjects without atrial fibrillation

Outcome

Dementiahard clinical

Atrial fibrillation is associated with a significantly increased risk of developing dementia and Alzheimer's disease, with a slightly higher relative risk observed in studies with shorter follow-up (<10 years).

Implication

Provides first meta-analysis of short- versus long-term AF-dementia risk; leaves open whether duration modifies association in observational data.

Abstract

Background No previous meta‐analyses have compared the risk of dementia, due to an underlying atrial fibrillation (AF), in the short‐term versus the long‐term period. Aim To perform an update meta‐analysis of studies examining the association between AF and dementia and the relative impact of follow‐up period. Methods Data were obtained searching MEDLINE and Scopus for all investigations published between 1 January 2000 and March 1, 2021 reporting the risk of dementia in AF patients. The following MeSH terms were used for the search: “Atrial Fibrillation” AND “Dementia” OR “Alzheimer’s disease”. From each study, the adjusted hazard ratio (aHR) with the related 95% confidence interval (CI) was pooled using a random effect model. Results The analysis was carried out on 18 studies involving 3.559.349 subjects, of which 902.741 (25.3%) developed dementia during follow‐up. A random effect model revealed an aHR of 1.40 (95% CI: 1.27–1.54, p < 0.0001; I 2 = 93.5%) for dementia in subjects with AF. Stratifying the studies according to follow‐up duration, those having a follow‐up ≥10 years showed an aHR for dementia of 1.37 (95% CI: 1.21–1.55, p < 0.0001, I 2 = 96.6%), while those with a follow‐up duration <10 years has a slightly higher aHR for dementia (HR: 1.59, 95%CI: 1.51–1.67, p < 0.0001, I 2 = 49%). Nine studies showed that the aHR for Alzheimer’s disease (AD) in AF patients was 1.30 (95%CI: 1.12–1.51, p < 0.0001, I 2 = 87.6%). Conclusions Evidence suggests that patients with AF have an increased risk of developing dementia and AD. The risk of dementia was slightly higher when the follow‐up was shorter than 10 years.