Vascular dementia, Alzheimer’s disease influence outcomes for people with AF
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Key takeaways:
- Atrial fibrillation with vascular dementia increases stroke, hospitalization and death risk compared with AF with Alzheimer’s disease.
- AF with Alzheimer’s disease raises risk for intercranial hemorrhage.
Adults with atrial fibrillation and vascular dementia have a higher risk for stroke, rehospitalization and mortality compared with those with AF and Alzheimer’s disease, who have a higher risk for intercranial hemorrhage, data show.
“While the epidemiological association between AF and dementia has been well documented, the clinical implications have been scarcely investigated,” José Miguel Rivera‐Caravaca, RN, PhD, of the faculty of nursing at the University of Murcia, Spain, and colleagues wrote in Clinical Cardiology. “Current guidelines on AF recommend the use of oral anticoagulation therapy in patients with dementia according to their CHA2DS2‐VASc score and good control of risk factors, but do not suggest any clinical utility in differentiating between dementia subtypes.”
Rivera-Caravaca and colleagues analyzed data from 1,230 people with AF and a diagnosis of vascular dementia (n = 615) or Alzheimer’s disease (n = 615) using the TriNetX database, a global health research network with real-time updates of electronic medical records. Researchers used propensity score matching to balance patients stratified by dementia type and followed the cohort for 4 years for incident intracranial hemorrhages (ICH), the composite of ischemic stroke/transient ischemic attack (TIA), hospitalization and all‐cause mortality.
During follow-up, 3.6% of patients with vascular dementia and 8.1% of patients with Alzheimer’s disease had incident ICH during follow‐up (HR = 2.22; 95% CI, 1.33-3.7; log‐rank P = .002). Overall, 38.5% of patients with vascular dementia and 31.4% of patients with Alzheimer’s disease developed an ischemic stroke/TIA. The risk for ischemic stroke/TIA was 1.32‐fold higher among people with vascular dementia (HR = 1.32; 95% CI, 1.09-1.59; log‐rank P = .003).
Researchers also found that people with vascular dementia were more likely to experience rehospitalization (HR = 1.14; 95% CI, 1.01-1.31), and all-cause death (HR = 1.25; 95% CI, 1.01-1.58) compared with people with Alzheimer’s disease.
“Considering our results, there is a need for a more holistic or integrated care approach to patients with AF, which has been associated with an improved clinical prognosis,” the researchers wrote. “Such an integrated management should also consider dementia risk, as it not only impacts on cognitive decline and quality of life but also on the risk of other subsequent worse clinical outcomes.”
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