Key result
Atrial fibrillation was associated with a significantly higher risk of new-onset dementia compared to atrial flutter (HR 1.14, 95% CI 1.04-1.25; p=0.0064) after propensity score matching.
Why the study?
AF and AFL carry different stroke risks, but little is known about differences in the risk of dementia between the two arrhythmias.
Does atrial fibrillation increase the risk of dementia compared to atrial flutter in adult patients?
Cohort (n=239,994)
Yes
Does atrial fibrillation increase the risk of dementia compared to atrial flutter in adult patients?
Atrial fibrillation is associated with a significantly higher risk of new-onset dementia compared to atrial flutter, particularly in patients without a prior history of stroke.
Answers are grounded in this paper and cite their sources.
AF may warrant subtype-specific dementia risk counseling; leaves open whether rhythm control or anticoagulation modifies this observational association.
Objectives: Atrial fibrillation (AF) is linked to an increased risk of stroke and dementia. Atrial flutter (AFL) is also linked to an increased risk of stroke but at a different level of risk as compared to AF. Little is known about the difference in the risk of dementia between AF and AFL. This study aims to investigate whether the risk of dementia is different between AF and AFL. Methods: Patients with newly diagnosed AF and AFL during 2001–2013 were retrieved from Taiwan's National Health Insurance Research Database. Patients with incomplete demographic data, aged <20 years, history of valvular surgery, rheumatic heart disease, hyperthyroidism, and history of dementia were excluded. The incidence of new-onset dementia was set as the primary outcome and analyzed in patients with AF and AFL after propensity score matching (PSM). Results: A total of 232,425 and 7,569 patients with AF and AFL, respectively, were eligible for analysis. After 4:1 PSM, we included 30,276 and 7,569 patients with AF and AFL, respectively, for analysis. Additionally, patients with AF ( n = 29,187) and AFL ( n = 451) who received oral anticoagulants were enrolled for comparison. The risk of dementia was higher in patients with AF compared with patients with AFL (subdistribution hazard ratio (SHR) = 1.52, 95% CI 1.39–1.66; p < 0.0001) before PSM and remained higher in patients with AF (SHR = 1.14, 95% CI 1.04–1.25; p = 0.0064) after PSM. The risk of dementia was higher in patients with AF without previous history of stroke after PSM but the risk did not differ between patients with AF and AFL with previous history of stroke. Among patients who received oral anticoagulants, the cumulative incidences of dementia were significantly higher in patients with AF than in patients with AFL before and after PSM (all P < 0.05). Conclusions: This study found that, among patients without history of stroke, the risk of dementia was higher in patients with AF than in patients with AFL, and CHA 2 DS 2 -VASc score might be useful for risk stratification of dementia between patients with AF and AFL.
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Wang et al. (2021) conducted a cohort in Atrial Fibrillation and Atrial Flutter (n=239,994). Atrial fibrillation vs. Atrial flutter was evaluated on Incidence of new-onset dementia (HR 1.14, 95% CI 1.04-1.25, p=0.0064). Atrial fibrillation was associated with a significantly higher risk of new-onset dementia compared to atrial flutter (HR 1.14, 95% CI 1.04-1.25; p=0.0064) after propensity score matching.
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