Association of rhythm control with incident dementia among patients with atrial fibrillation: a nationwide population-based cohort study

Daehoon Kim, Pil Sung Yang, Seng Chan You, Jung Hoon Sung, Eunsun Jang, Hee Tae Yu, Tae Hoon Kim, Hui Nam Pak, Moon Hyoung Lee, Gregory Y.H. Lip, Boyoung Joung

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Background: Atrial fibrillation (AF) increases the risk of dementia, and catheter ablation of AF may be associated with a lower risk of dementia. We investigated the association of a rhythm-control strategy for AF with the risk of dementia, compared with a rate-control strategy. Methods: This population-based cohort study included 41,135 patients with AF on anticoagulation who were newly treated with rhythm-control (anti-arrhythmic drugs or ablation) or rate-control strategies between 1 January 2005 and 31 December 2015 from the Korean National Health Insurance Service database. The primary outcome was all-cause dementia, which was compared using propensity score overlap weighting. Results: In the study population (46.7% female; median age: 68 years), a total of 4,039 patients were diagnosed with dementia during a median follow-up of 51.7 months. Rhythm control, compared with rate control, was associated with decreased dementia risk (weighted incidence rate: 21.2 versus 25.2 per 1,000 person-years; subdistribution hazard ratio [sHR] 0.86, 95% confidence interval [CI] 0.80-0.93). The associations between rhythm control and decreased dementia risk were consistently observed even after censoring for incident stroke (sHR 0.89, 95% CI 0.82-0.97) and were more pronounced in relatively younger patients and those with lower CHA2DS2-VASc scores. Among dementia subtypes, rhythm control was associated with a lower risk of Alzheimer's disease (sHR 0.86, 95% CI 0.79-0.95). Conclusions: Among anticoagulated patients with AF, rhythm control was associated with a lower risk of dementia, compared with rate control. Initiating rhythm control in AF patients with fewer stroke risk factors might help prevent subsequent dementia.

Original languageEnglish
Article numberafab248
JournalAge and Ageing
Volume51
Issue number1
DOIs
Publication statusPublished - 2022 Jan 1

Bibliographical note

Publisher Copyright:
© 2022 The Author(s) 2022.

All Science Journal Classification (ASJC) codes

  • Ageing
  • Geriatrics and Gerontology

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