Early Rhythm Control and Incident Dementia in Patients With Atrial Fibrillation and Prior Stroke

So-Ryoung Lee; Eue-Keun Choi; Seung-Woo Lee; Kyung-Do Han; Seil Oh; Gregory Y H Lip

doi:10.1016/j.jacep.2024.03.007

Early Rhythm Control and Incident Dementia in Patients With Atrial Fibrillation and Prior Stroke

JACC Clin Electrophysiol. 2024 Apr 18:S2405-500X(24)00188-9. doi: 10.1016/j.jacep.2024.03.007. Online ahead of print.

Authors

So-Ryoung Lee¹, Eue-Keun Choi², Seung-Woo Lee³, Kyung-Do Han⁴, Seil Oh¹, Gregory Y H Lip⁵

Affiliations

¹ Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
² Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: choiek17@snu.ac.kr.
³ Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea.
⁴ Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
⁵ Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest and Heart Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

PMID: 38727665
DOI: 10.1016/j.jacep.2024.03.007

Abstract

Background: Although early rhythm control (ERC) in patients with atrial fibrillation (AF) reduces the risk of stroke, there is no evidence thus far on whether ERC reduces the risk of developing dementia in patients with AF and prior stroke.

Objectives: This study sought to evaluate whether ERC reduces the risk of developing dementia in patients with new-onset AF and prior stroke.

Methods: Using the Korean nationwide claims database, we identified patients with new-onset AF and prior stroke between 2010 and 2016. Patients who received rhythm control therapy within 1 year after AF onset were defined as the ERC group, otherwise patients were categorized as the usual care group. A propensity score weighting method was used to balance the 2 groups. Incident dementia defined by relevant diagnostic codes was evaluated.

Results: A total of 41,370 patients were included (mean age 70 ± 11 years; mean CHA₂DS₂-VASc score 5.3±1.6): 10,213 in the ERC group and 31,157 in the usual care group. Compared with usual care, ERC was associated with lower risks of all dementia, Alzheimer's dementia, and vascular dementia (weighted HRs [95% CIs], 0.825 [0.776-0.876], 0.831 [0.774-0.893], and 0.800 [0.702-0.913], respectively, all P < 0.001). The benefit of ERC was slightly accentuated in the younger age group (<65 years). The beneficial effect of ERC in reducing the risk of dementia was consistent regardless of the characteristics of prior stroke.

Conclusions: ERC might be beneficial in the prevention of dementia in patients with AF and prior stroke. To prevent the progression of cognitive dysfunction, ERC should be considered in this population.

Keywords: atrial fibrillation; dementia; early rhythm control; prior stroke.