Kevin G Graves1, Heidi T May2, Victoria Jacobs2, Kirk U Knowlton2, Joseph B Muhlestein3, Donald L Lappe3, Jeffrey L Anderson3, Benjamin D Horne1, T Jared Bunch4. 1. Intermountain Heart Institute, Intermountain Medical Center, University of Utah, Salt Lake City, Utah; Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah. 2. Intermountain Heart Institute, Intermountain Medical Center, University of Utah, Salt Lake City, Utah. 3. Intermountain Heart Institute, Intermountain Medical Center, University of Utah, Salt Lake City, Utah; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah. 4. Intermountain Heart Institute, Intermountain Medical Center, University of Utah, Salt Lake City, Utah; Stanford University, Department of Internal Medicine, Palo Alto, California. Electronic address: Thomas.bunch@imail.org.
Abstract
BACKGROUND: High CHA2DS2-VASc scores in atrial fibrillation (AF) patients are generally associated with increased risks of stroke and dementia. At lower CHA2DS2-VASc scores, there remains an unquantifiable cranial injury risk, necessitating an improved risk assessment method within these lower-risk groups. OBJECTIVE: The purpose of this study was to determine whether sex-specific Intermountain Mortality Risk Scores (IMRS), a dynamic measures of systemic health that comprises commonly performed blood tests, can stratify dementia risk overall and among CHA2DS2-VASc score strata in AF patients. METHODS: Female (n = 34,083) and male (n = 39,998) AF patients with no history of dementia were studied. CHA2DS2-VASc scores were assessed at the time of AF diagnosis and were stratified into scores of 0-1, 2, and ≥3. Within each CHA2DS2-VASc score stratum, patients were further stratified by IMRS categories of low, moderate, and high. Multivariable Cox hazard regression was used to determine dementia risk. RESULTS: High-risk IMRS patients were generally older and had higher rates of hypertension, diabetes, heart failure, and prior stroke. Higher CHA2DS2-VASc score strata (≥3 vs ≤1: women, hazard ratio [HR] 7.77, 95% confidence interval [CI] 5.94-10.17, P < .001; men: HR 4.75, 95% CI 4.15-5.44, P < .001) and IMRS categories (high vs low: women, HR 3.09, 95% CI 2.71-3.51, P < .001; men, HR 2.70, 95% CI 2.39-3.06, P < .001) were predictive of dementia. When stratified by CHA2DS2-VASc scores, IMRS further identified risk in each stratum. CONCLUSION: Both CHA2DS2-VASc scores and IMRS were independently associated with dementia incidence among AF patients. IMRS further stratified dementia risk among CHA2DS2-VASc score strata, particularly among those with lower CHA2DS2-VASc scores.
BACKGROUND: High CHA2DS2-VASc scores in atrial fibrillation (AF) patients are generally associated with increased risks of stroke and dementia. At lower CHA2DS2-VASc scores, there remains an unquantifiable cranial injury risk, necessitating an improved risk assessment method within these lower-risk groups. OBJECTIVE: The purpose of this study was to determine whether sex-specific Intermountain Mortality Risk Scores (IMRS), a dynamic measures of systemic health that comprises commonly performed blood tests, can stratify dementia risk overall and among CHA2DS2-VASc score strata in AFpatients. METHODS: Female (n = 34,083) and male (n = 39,998) AFpatients with no history of dementia were studied. CHA2DS2-VASc scores were assessed at the time of AF diagnosis and were stratified into scores of 0-1, 2, and ≥3. Within each CHA2DS2-VASc score stratum, patients were further stratified by IMRS categories of low, moderate, and high. Multivariable Cox hazard regression was used to determine dementia risk. RESULTS: High-risk IMRS patients were generally older and had higher rates of hypertension, diabetes, heart failure, and prior stroke. Higher CHA2DS2-VASc score strata (≥3 vs ≤1: women, hazard ratio [HR] 7.77, 95% confidence interval [CI] 5.94-10.17, P < .001; men: HR 4.75, 95% CI 4.15-5.44, P < .001) and IMRS categories (high vs low: women, HR 3.09, 95% CI 2.71-3.51, P < .001; men, HR 2.70, 95% CI 2.39-3.06, P < .001) were predictive of dementia. When stratified by CHA2DS2-VASc scores, IMRS further identified risk in each stratum. CONCLUSION: Both CHA2DS2-VASc scores and IMRS were independently associated with dementia incidence among AFpatients. IMRS further stratified dementia risk among CHA2DS2-VASc score strata, particularly among those with lower CHA2DS2-VASc scores.
Authors: Lindsey Snyder; Scott M Stevens; Masarret Fazili; Emily L Wilson; James F Lloyd; Benjamin D Horne; Joseph Bledsoe; Scott C Woller Journal: Res Pract Thromb Haemost Date: 2020-05-20
Authors: Tyson S Burnham; Monte L Scott; Benjamin A Steinberg; Daniel L Varela; Brian Zenger; T Jared Bunch Journal: Arrhythm Electrophysiol Rev Date: 2021-10
Authors: Benjamin D Horne; Joseph R Bledsoe; Joseph B Muhlestein; Heidi T May; Ithan D Peltan; Brandon J Webb; John F Carlquist; Sterling T Bennett; Susan Rea; Tami L Bair; Colin K Grissom; Stacey Knight; Brianna S Ronnow; Viet T Le; Edward Stenehjem; Scott C Woller; Kirk U Knowlton; Jeffrey L Anderson Journal: BMJ Open Date: 2022-03-24 Impact factor: 2.692