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Atrial Fibrillation on Patients with Vascular Dementia: A Fundamental Target for Correct Management

Giovanna Viticchi1, Lorenzo Falsetti2, Marco Burattini1

  • 1Neurological Clinic, Marche Polytechnic University, 60020 Ancona, Italy.

Brain Sciences
|July 8, 2020
PubMed

Insights

Patients with atrial fibrillation and vascular dementia were undertreated with anticoagulants, increasing their stroke risk. Adherence to guidelines is crucial for managing this high-risk group.

Area of Science:

  • Cardiology
  • Neurology
  • Geriatrics

Background:

  • Atrial fibrillation (AF) is a known risk factor for cerebrovascular diseases, including vascular dementia (VAD).
  • Effective anticoagulant therapy is vital for preventing adverse events in AF patients.
  • Assessing guideline adherence in VAD patients with AF is critical for stroke prevention.

Purpose of the Study:

  • To evaluate anticoagulant therapy guideline adherence in patients with both dementia and AF.
  • To assess the impact of adherence on the risk of stroke/TIA or major bleeding (MB).

Main Methods:

  • A cohort study of 1705 hospitalized patients with pre-existent AF, including 193 with VAD.
  • Calculation of CHA2DS2-VASc, CHADS2, and HAS-BLED scores for risk assessment.
  • Collection of data on anticoagulant therapy, therapeutic failure (TF), stroke/TIA, and MB.

Main Results:

  • 99.5% of VAD patients had an indication for anticoagulation, but only 69.9% received appropriate treatment.
  • VAD patients experienced significantly higher in-hospital stroke/TIA rates (24.3%) compared to non-demented patients (0.8%).
  • Major bleeding (MB) rates were comparable between VAD (4.66%) and non-demented patients (8.9%), with similar therapeutic failure rates.

Conclusions:

  • Vascular dementia patients with atrial fibrillation are frequently undertreated with anticoagulants.
  • This undertreatment is associated with a higher risk of stroke/TIA compared to non-demented AF patients.
  • Improved adherence to anticoagulant therapy guidelines is essential for VAD patients with AF.
Abstract

Keywords:
CHA2DS2-VAS scoreHAS-BLED scoreanticoagulantsatrial fibrillationvascular dementia

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