Differential Risk of Dementia Between Patients With Atrial Flutter and Atrial Fibrillation: A National Cohort Study
Objectives: Atrial fibrillation (AF) is linked to an increased risk of stroke and dementia. Atrial flutter (AFL) is also linked to an increased risk of stroke but at a different level of risk as compared to AF. Little is known about the difference in the risk of dementia between AF and AFL. This stu...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:3d66f4f1d9b04549bf437b8abf4a6c042021-11-18T06:09:45ZDifferential Risk of Dementia Between Patients With Atrial Flutter and Atrial Fibrillation: A National Cohort Study2297-055X10.3389/fcvm.2021.787866https://doaj.org/article/3d66f4f1d9b04549bf437b8abf4a6c042021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.787866/fullhttps://doaj.org/toc/2297-055XObjectives: Atrial fibrillation (AF) is linked to an increased risk of stroke and dementia. Atrial flutter (AFL) is also linked to an increased risk of stroke but at a different level of risk as compared to AF. Little is known about the difference in the risk of dementia between AF and AFL. This study aims to investigate whether the risk of dementia is different between AF and AFL.Methods: Patients with newly diagnosed AF and AFL during 2001–2013 were retrieved from Taiwan's National Health Insurance Research Database. Patients with incomplete demographic data, aged <20 years, history of valvular surgery, rheumatic heart disease, hyperthyroidism, and history of dementia were excluded. The incidence of new-onset dementia was set as the primary outcome and analyzed in patients with AF and AFL after propensity score matching (PSM).Results: A total of 232,425 and 7,569 patients with AF and AFL, respectively, were eligible for analysis. After 4:1 PSM, we included 30,276 and 7,569 patients with AF and AFL, respectively, for analysis. Additionally, patients with AF (n = 29,187) and AFL (n = 451) who received oral anticoagulants were enrolled for comparison. The risk of dementia was higher in patients with AF compared with patients with AFL (subdistribution hazard ratio (SHR) = 1.52, 95% CI 1.39–1.66; p < 0.0001) before PSM and remained higher in patients with AF (SHR = 1.14, 95% CI 1.04–1.25; p = 0.0064) after PSM. The risk of dementia was higher in patients with AF without previous history of stroke after PSM but the risk did not differ between patients with AF and AFL with previous history of stroke. Among patients who received oral anticoagulants, the cumulative incidences of dementia were significantly higher in patients with AF than in patients with AFL before and after PSM (all P < 0.05).Conclusions: This study found that, among patients without history of stroke, the risk of dementia was higher in patients with AF than in patients with AFL, and CHA2DS2-VASc score might be useful for risk stratification of dementia between patients with AF and AFL.Hui-Ting WangYung-Lung ChenYung-Lung ChenYu-Sheng LinYu-Sheng LinHuang-Chung ChenShaur-Zheng ChongShukai HsuehChang-Ming ChungMien-Cheng ChenFrontiers Media S.A.articleatrial fibrillationatrial flutterdementiastrokeCHA2DS2-VASc scoreDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021) |
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| collection |
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| topic |
atrial fibrillation atrial flutter dementia stroke CHA2DS2-VASc score Diseases of the circulatory (Cardiovascular) system RC666-701 |
| spellingShingle |
atrial fibrillation atrial flutter dementia stroke CHA2DS2-VASc score Diseases of the circulatory (Cardiovascular) system RC666-701 Hui-Ting Wang Yung-Lung Chen Yung-Lung Chen Yu-Sheng Lin Yu-Sheng Lin Huang-Chung Chen Shaur-Zheng Chong Shukai Hsueh Chang-Ming Chung Mien-Cheng Chen Differential Risk of Dementia Between Patients With Atrial Flutter and Atrial Fibrillation: A National Cohort Study |
| description |
Objectives: Atrial fibrillation (AF) is linked to an increased risk of stroke and dementia. Atrial flutter (AFL) is also linked to an increased risk of stroke but at a different level of risk as compared to AF. Little is known about the difference in the risk of dementia between AF and AFL. This study aims to investigate whether the risk of dementia is different between AF and AFL.Methods: Patients with newly diagnosed AF and AFL during 2001–2013 were retrieved from Taiwan's National Health Insurance Research Database. Patients with incomplete demographic data, aged <20 years, history of valvular surgery, rheumatic heart disease, hyperthyroidism, and history of dementia were excluded. The incidence of new-onset dementia was set as the primary outcome and analyzed in patients with AF and AFL after propensity score matching (PSM).Results: A total of 232,425 and 7,569 patients with AF and AFL, respectively, were eligible for analysis. After 4:1 PSM, we included 30,276 and 7,569 patients with AF and AFL, respectively, for analysis. Additionally, patients with AF (n = 29,187) and AFL (n = 451) who received oral anticoagulants were enrolled for comparison. The risk of dementia was higher in patients with AF compared with patients with AFL (subdistribution hazard ratio (SHR) = 1.52, 95% CI 1.39–1.66; p < 0.0001) before PSM and remained higher in patients with AF (SHR = 1.14, 95% CI 1.04–1.25; p = 0.0064) after PSM. The risk of dementia was higher in patients with AF without previous history of stroke after PSM but the risk did not differ between patients with AF and AFL with previous history of stroke. Among patients who received oral anticoagulants, the cumulative incidences of dementia were significantly higher in patients with AF than in patients with AFL before and after PSM (all P < 0.05).Conclusions: This study found that, among patients without history of stroke, the risk of dementia was higher in patients with AF than in patients with AFL, and CHA2DS2-VASc score might be useful for risk stratification of dementia between patients with AF and AFL. |
| format |
article |
| author |
Hui-Ting Wang Yung-Lung Chen Yung-Lung Chen Yu-Sheng Lin Yu-Sheng Lin Huang-Chung Chen Shaur-Zheng Chong Shukai Hsueh Chang-Ming Chung Mien-Cheng Chen |
| author_facet |
Hui-Ting Wang Yung-Lung Chen Yung-Lung Chen Yu-Sheng Lin Yu-Sheng Lin Huang-Chung Chen Shaur-Zheng Chong Shukai Hsueh Chang-Ming Chung Mien-Cheng Chen |
| author_sort |
Hui-Ting Wang |
| title |
Differential Risk of Dementia Between Patients With Atrial Flutter and Atrial Fibrillation: A National Cohort Study |
| title_short |
Differential Risk of Dementia Between Patients With Atrial Flutter and Atrial Fibrillation: A National Cohort Study |
| title_full |
Differential Risk of Dementia Between Patients With Atrial Flutter and Atrial Fibrillation: A National Cohort Study |
| title_fullStr |
Differential Risk of Dementia Between Patients With Atrial Flutter and Atrial Fibrillation: A National Cohort Study |
| title_full_unstemmed |
Differential Risk of Dementia Between Patients With Atrial Flutter and Atrial Fibrillation: A National Cohort Study |
| title_sort |
differential risk of dementia between patients with atrial flutter and atrial fibrillation: a national cohort study |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/3d66f4f1d9b04549bf437b8abf4a6c04 |
| work_keys_str_mv |
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