Risk Factors for Dementia in Patients With Atrial Fibrillation

• Type of Material: Article
• Authors: Alvaro Alonso, Emory University; Aniqa B Alam, Emory University; Pamela L Lutsey, University of Minnesota, Minneapolis, MN, USA; Lin Y Chen, University of Minnesota, Minneapolis, MN, USA; Richard F MacLehose, University of Minnesota, Minneapolis, MN, USA; Iris Y Shao, Emory University
• Language: English
• Date: 2022-05-26
• Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 Elsevier Inc
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjcard.2022.03.029
• Title of Journal or Parent Work: AMERICAN JOURNAL OF CARDIOLOGY
• Volume: 174
• Start Page: 48
• End Page: 52
• Keywords: EPIDEMIOLOGY; BURDEN; Cardiac & Cardiovascular Systems; WEIGHT-LOSS; Science & Technology; Life Sciences & Biomedicine; COGNITIVE DECLINE; Cardiovascular System & Cardiology; BARIATRIC SURGERY
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

Abstract

Although dementia and atrial fibrillation (AF) are common in older adults, risk factors for dementia have not been sufficiently characterized in patients with AF. We studied 621,773 patients with AF without dementia at the time of AF diagnosis who were enrolled in the MarketScan Commercial and Medicare Supplemental databases from 2007 to 2015. Dementia incidence and presence of predictors at the time of AF diagnosis (cardiometabolic conditions, mental and neurologic disorders, and other chronic conditions) were based on International Classification of Diseases, Ninth Revision, Clinical Modification codes in outpatient and inpatient claims, whereas medication usage was based on outpatient pharmacy claims. A frailty score was calculated using a previously established algorithm. The associations between the predictors of interest and dementia were assessed with multivariable Cox models. Patients had a mean age of 68 years (SD 14 years) and 41% were women. During a mean follow-up of 2.0 years, there were 16,073 cases of dementia. The strongest predictors of dementia were frailty (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.40 to 1.45, per 1-SD increase in the score), cognitive impairment (HR 1.50, 95% CI 1.36 to 1.65), mood disorders (HR 1.49, 95% CI 1.32 to 1.70), schizophrenia (HR 1.86, 95% CI 1.75 to 1.98), and substance abuse (HR 1.58, 95% CI 1.39 to 1.80). Among cardiometabolic conditions, only stroke (HR 1.17, 95% CI 1.13 to 1.22) and diabetes mellitus (HR 1.14, 95% CI 1.11 to 1.18) were associated with small increases in dementia risk after adjusting for demographics, frailty, co-morbidities, and medications. We have identified several risk factors for dementia in patients with AF.