Affiliation:
1. Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT
2. Department of Internal Medicine, Stanford University, Palo Alto, CA
Abstract
Background
The mechanisms behind the association of atrial fibrillation (
AF
) and dementia are unknown. We previously found a significantly increased risk of dementia in
AF
patients taking warfarin with a low percentage of time in therapeutic range. The purpose of this study was to determine the extent to which
AF
itself increases dementia risk, in addition to long‐term anticoagulation exposure.
Methods and Results
A total of 10 537 patients anticoagulated with warfarin (target
INR
2–3), managed by the Clinical Pharmacist Anticoagulation Service with no history of dementia were included. Warfarin indication was for
AF
(n=4460), thromboembolism (n=5868), and mechanical heart valve(s) (n=209). Patients in the latter 2 categories were included only if they had no prior history of
AF
. The primary outcome was dementia. Patients with
AF
were older and had higher rates of hypertension, diabetes, heart failure, and stroke.
AF
patients experienced higher rates of total dementia (5.8% versus 1.6%,
P
<0.0001), Alzheimer disease (2.8% versus 0.9%,
P
<0.0001), and vascular dementia (1.0% versus 0.2%,
P
<0.0001). A propensity analysis of 6030 patients was performed to account for baseline demographics differences. Long‐term risk of dementia remained significant in
AF
patients compared with matched non‐
AF
patients (total dementia: hazard ratio [HR]=2.42 [1.85–3.18],
P
<0.0001; Alzheimer:
HR
=2.04 [1.40–2.98],
P
<0.0001; senile:
HR
=2.46 [1.58–3.86],
P
<0.0001). Low percent therapeutic range compared with a higher percent therapeutic range was associated with dementia risk in both
AF
(26–50% versus >75%:
HR
=2.51,
P
=0.005) and non‐
AF
groups (≤25% versus >75%:
HR
=3.92,
P
<0.0001).
Conclusions
The presence of
AF
significantly increases risk of dementia, including Alzheimer's disease, compared with matched patients receiving warfarin anticoagulation for other reasons. Quality of anticoagulation management remains an important risk factor for dementia in all patients.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
46 articles.
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