Key result
In AF patients, vascular dementia was associated with a higher risk of ischemic stroke/TIA (HR 1.32; 95% CI 1.09-1.59) compared to Alzheimer's disease, which had a higher risk of ICH.
Why the study?
AF is associated with higher risks of Alzheimer's disease and vascular dementia, but the clinical implications have been scarcely investigated.
Does the type of dementia (Alzheimer's disease vs. vascular dementia) affect the risk of adverse outcomes in patients with atrial fibrillation?
Cohort (n=2,377)
Yes
Does the type of dementia (Alzheimer's disease vs. vascular dementia) affect the risk of adverse outcomes in patients with atrial fibrillation?
Hazard Ratio: 1.32 (95% CI 1.09–1.59)
Absolute Event Rate: 38.5% vs 31.4%
p-value: p=0.003
In patients with atrial fibrillation, the type of coexisting dementia carries different prognostic implications, with Alzheimer's disease linked to higher ICH risk and vascular dementia to higher ischemic stroke and mortality risks.
AF patients with AD/vascular dementia show higher adverse event rates; hypothesis-generating for risk stratification, prospective trials needed before practice change.
BACKGROUND: Atrial fibrillation (AF) associates with higher Alzheimer's disease (AD) and vascular dementia risks but the clinical implications have been scarcely investigated. We examined the association between AD or vascular dementia and adverse outcomes in AF patients. METHODS: Cohort study between January 2000 and 2017. AF patients were divided into two groups according to vascular dementia or AD, and balanced using propensity score matching (PSM). During 4-years of follow-up, incident intracranial hemorrhages (ICH), the composite of ischemic stroke/transient ischemic attack (TIA), hospitalizations, and all-cause deaths, were recorded. RESULTS: Two thousand three hundred seventy-seven AF patients with dementia (1225 with vascular dementia, and 1152 with AD) were identified. Following a PSM, 615 patients were included in each cohort (i.e., 1:1) and all variables were well-matched. After PSM, 22 (3.6%) patients with vascular dementia and 55 (8.1%) patients with AD had incident ICH during follow-up (hazard ratio [HR]: 2.22, 95% confidence interval [CI]: 1.33-3.70, log-rank p = 0.002). Overall, 237 (38.5%) patients with vascular dementia and 193 (31.4%) patients with AD, developed an ischemic stroke/TIA. The risk of ischemic stroke/TIA was 1.32-fold higher in vascular dementia (HR: 1.32, 95% CI: 1.09-1.59, log-rank p = 0.003). The risk of rehospitalization (HR: 1.14, 95% CI: 1.01-1.31), and mortality (HR: 1.25, 95% CI: 1.01-1.58) were also higher among AF patients with vascular dementia compared to AD. CONCLUSIONS: The two forms of dementia in AF patients are associated with different prognosis, with AD being associated with a higher risk of ICH, and vascular dementia with a higher risk of stroke/TIA, hospitalization, and mortality.
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Proietti et al. (2023) conducted a cohort in Atrial fibrillation with dementia (n=2,377). Vascular dementia vs. Alzheimer's disease was evaluated on Composite of ischemic stroke/transient ischemic attack (TIA) (HR 1.32, 95% CI 1.09-1.59, p=0.003). In AF patients, vascular dementia was associated with a higher risk of ischemic stroke/TIA (HR 1.32; 95% CI 1.09-1.59) compared to Alzheimer's disease, which had a higher risk of ICH.
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