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Differential Risk of Dementia Between Patients With Atrial Flutter and Atrial Fibrillation: A National Cohort Study

Hui-Ting Wang1, Yung-Lung Chen2,3, Yu-Sheng Lin3,4

  • 1Department of Emergency, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

Frontiers in Cardiovascular Medicine
|December 6, 2021
PubMed

Insights

Patients with atrial fibrillation (AF) face a higher dementia risk than those with atrial flutter (AFL). This difference is particularly notable in individuals without a prior stroke history, suggesting AF increases dementia risk.

Area of Science:

  • Cardiology
  • Neurology
  • Epidemiology

Background:

  • Atrial fibrillation (AF) and atrial flutter (AFL) are common arrhythmias associated with increased risks of stroke and dementia.
  • While stroke risks differ between AF and AFL, the comparative risk of dementia remains less understood.
  • Understanding these differences is crucial for patient risk stratification and management.

Purpose of the Study:

  • To investigate and compare the risk of developing dementia in patients diagnosed with atrial fibrillation versus atrial flutter.
  • To determine if the risk of dementia differs significantly between these two common cardiac arrhythmias.

Main Methods:

  • Retrospective cohort study using Taiwan's National Health Insurance Research Database (2001-2013).
  • Inclusion of newly diagnosed AF and AFL patients, excluding those with specific comorbidities or incomplete data.
  • Propensity score matching (PSM) applied to compare outcomes between AF and AFL groups, with dementia incidence as the primary outcome.

Main Results:

  • After PSM, patients with AF showed a significantly higher risk of dementia compared to patients with AFL (SHR = 1.14, p=0.0064).
  • This elevated risk in AF patients was observed particularly in those without a prior history of stroke.
  • Among patients receiving oral anticoagulants, AF was associated with a higher cumulative incidence of dementia compared to AFL.

Conclusions:

  • Atrial fibrillation is associated with an increased risk of dementia compared to atrial flutter, especially in patients without a history of stroke.
  • The CHA2DS2-VASc score may aid in stratifying dementia risk between AF and AFL patients.
  • Further research is warranted to elucidate the mechanisms underlying the differential dementia risk between AF and AFL.

Keywords:
CHA2DS2-VASc scoreatrial fibrillationatrial flutterdementiastroke

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