Framingham dementia risk score ‘appropriate’ predictor of Alzheimer’s disease in HF, AF
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Variables from the Framingham Dementia Risk Score are an accurate predictor of Alzheimer’s disease or without the addition of other variables, researchers reported.
The Framingham Heart Study Dementia Risk Score, or FDRS, was recently developed in a general population of older adults as a tool for general practitioners, using information that is commonly available in the electronic health record, according to the researchers. However, it is unknown how FDRS variables can predict Alzheimer’s disease or related dementias in HF and AF.
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“Both AF and HF are conditions that require effective self-management that in turn relies on cognitive function; thus, having the ability to identify patients at risk for Alzheimer’s disease or Alzheimer’s dementia-related diseases could have great implications for patient management and outcomes in these individuals,” Sheila M. Manemann, MPH, of the department of quantitative health sciences at Mayo Clinic in Rochester, Minnesota, and colleagues wrote. “We recently reported that in a population of patients with HF, Alzheimer’s disease or Alzheimer’s dementia-related diseases both prior to and after a diagnosis was HF was associated with an increased risk of health care utilization and death. Thus, by identifying HF and AF patients at risk for Alzheimer’s disease or Alzheimer’s dementia-related diseases, interventions could be targeted to these patients to potentially prevent or reduce the impact of Alzheimer’s disease or Alzheimer’s dementia-related diseases and in turn improve outcomes.”
Using data from the Rochester Epidemiology Project, Manemann and colleagues analyzed data from 3,052 adults with a first diagnosis of HF (mean age, 75 years; 53% men) and 4,107 adults with a first diagnosis AF (mean age, 74 years; 57% men) between January 2013 and December 2017, all aged 50 years and older from seven southeastern Minnesota counties.
Researchers excluded patients with Alzheimer’s disease or Alzheimer’s dementia-related diseases before or within 6 months after index atrial fibrillation or heart failure and patients who died within 6 months after index diagnosis. Researchers created models to predict Alzheimer’s disease or Alzheimer’s dementia-related diseases after index including the variables in the Framingham Dementia Risk Score — age, marital status, BMI, stroke/transient ischemic attack history, diabetes status and cancer history — and adding sex, smoking status, education level, and additional comorbidities identified by the U.S. Department of Health and Human Services.
The findings were published in the American Journal of Medicine.
During a mean follow-up of 3.5 years, 626 patients with HF and 736 patients with AF developed Alzheimer’s disease or Alzheimer’s dementia-related diseases.
Among HF patients, the FDRS variables predicted Alzheimer’s disease or Alzheimer’s dementia-related diseases with a C-statistic of 0.69; adding comorbidities and risk factors improved the C-statistic to 0.7.
The FDRS variables also performed well for patients with AF, with a C-statistic of 0.73; adding comorbidities and risk factors slightly the C-statistic to 0.75.
“The addition of comorbidities and other CVD risk factors only modestly improved prediction, indicating that the FDRS variables are appropriate to predict Alzheimer’s disease and Alzheimer’s disease related dementias in patients with HF and AF,” the researchers wrote. “Our results have important implications because the variables in the FDRS, as well as the additional comorbidities and risk factors, can be easily obtained from the EHR. Thus, using data that is easily accessible to clinicians may help predict who is at risk for Alzheimer’s disease or Alzheimer’s dementia-related diseases among patients with HF and AF.”
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