Jo-Nan Liao1, Tze-Fan Chao1, Chia-Jen Liu2, Kang-Ling Wang1, Su-Jung Chen3, Ta-Chuan Tuan1, Yenn-Jiang Lin1, Shih-Lin Chang1, Li-Wei Lo1, Yu-Feng Hu1, Fa-Po Chung1, Hsuan-Ming Tsao4, Tzeng-Ji Chen5, Gregory Y H Lip6, Shih-Ann Chen7. 1. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. 2. Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan. 3. Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 4. Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; National Yang-Ming University Hospital, Taiwan. Electronic address: hmtsao@ymuh.ym.edu.tw. 5. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 6. University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom. 7. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. Electronic address: epsachen@ms41.hinet.net.
Abstract
BACKGROUND: Atrial fibrillation (AF) is associated with an increased risk of cognitive impairment and functional decline, and may contribute to development of dementia. OBJECTIVES: Data from a nationwide large-scale population-based cohort study are lacking. Besides, how best to predict the occurrence of incident dementia among AF subjects remains uncertain. METHODS: A total of 332,665 AF subjects without dementia were identified as the study group from the "National Health Insurance Research Database" in Taiwan. For each study patient, one age- and sex-matched subject without AF and dementia was selected as the control group. The study end point was occurrence of dementia, and the usefulness of CHADS2 and CHA2DS2-VASc scores in predicting dementia was analyzed. RESULTS: During the follow-up, 29,012 AF patients experienced dementia with an annual incidence of 2.12%, higher than non-AF subjects (1.50%). Patients with AF possessed a higher risk of dementia with a hazard ratio (HR) of 1.420 after adjustments for age, gender, baseline differences and medication use. Among AF patients, the CHADS2 and CHA2DS2-VASc scores were significant predictors of dementia with an adjusted HR of 1.520 and 1.497 per 1 increment of the CHADS2 and CHA2DS2-VASc scores, respectively. The c-index for CHA2DS2-VASc in predicting dementia (0.611, 95% confidence interval [CI]=0.608-0.614) was significantly higher than the CHADS2 score (0.589, 95% CI=0.586-0.592) (DeLong test p<0.001). CONCLUSIONS: In this nationwide cohort study, AF was independently associated with a higher risk of dementia. The CHA2DS2-VASc score can be used to estimate the risk of dementia in AF patients.
BACKGROUND:Atrial fibrillation (AF) is associated with an increased risk of cognitive impairment and functional decline, and may contribute to development of dementia. OBJECTIVES: Data from a nationwide large-scale population-based cohort study are lacking. Besides, how best to predict the occurrence of incident dementia among AF subjects remains uncertain. METHODS: A total of 332,665 AF subjects without dementia were identified as the study group from the "National Health Insurance Research Database" in Taiwan. For each study patient, one age- and sex-matched subject without AF and dementia was selected as the control group. The study end point was occurrence of dementia, and the usefulness of CHADS2 and CHA2DS2-VASc scores in predicting dementia was analyzed. RESULTS: During the follow-up, 29,012 AFpatients experienced dementia with an annual incidence of 2.12%, higher than non-AF subjects (1.50%). Patients with AF possessed a higher risk of dementia with a hazard ratio (HR) of 1.420 after adjustments for age, gender, baseline differences and medication use. Among AFpatients, the CHADS2 and CHA2DS2-VASc scores were significant predictors of dementia with an adjusted HR of 1.520 and 1.497 per 1 increment of the CHADS2 and CHA2DS2-VASc scores, respectively. The c-index for CHA2DS2-VASc in predicting dementia (0.611, 95% confidence interval [CI]=0.608-0.614) was significantly higher than the CHADS2 score (0.589, 95% CI=0.586-0.592) (DeLong test p<0.001). CONCLUSIONS: In this nationwide cohort study, AF was independently associated with a higher risk of dementia. The CHA2DS2-VASc score can be used to estimate the risk of dementia in AFpatients.
Authors: Pavlos G Myserlis; Antonia Malli; Dimitrios K Kalaitzoglou; Grigorios Kalaitzidis; Michael Miligkos; Damianos G Kokkinidis; Andreas P Kalogeropoulos Journal: Heart Fail Rev Date: 2017-01 Impact factor: 4.214
Authors: Alvaro Alonso; David S Knopman; Rebecca F Gottesman; Elsayed Z Soliman; Amit J Shah; Wesley T O'Neal; Faye L Norby; Thomas H Mosley; Lin Y Chen Journal: J Am Heart Assoc Date: 2017-07-24 Impact factor: 5.501
Authors: Christos A Papanastasiou; Christina A Theochari; Nikos Zareifopoulos; Angelos Arfaras-Melainis; George Giannakoulas; Theodoros D Karamitsos; Leonidas Palaiodimos; George Ntaios; Konstantinos I Avgerinos; Dimitrios Kapogiannis; Damianos G Kokkinidis Journal: J Gen Intern Med Date: 2021-07-09 Impact factor: 6.473