Elsevier

Heart Rhythm

Volume 7, Issue 4, April 2010, Pages 433-437
Heart Rhythm

Clinical
Atrial fibrillation
Atrial fibrillation is independently associated with senile, vascular, and Alzheimer's dementia

https://doi.org/10.1016/j.hrthm.2009.12.004Get rights and content

Background

The aging population has resulted in more patients living with cardiovascular disease, such as atrial fibrillation (AF). Recent focus has been placed on understanding the long-term consequences of chronic cardiovascular disease, such as a potential increased risk of dementia.

Objective

This study sought to determine whether there is an association between AF and dementia and whether their coexistence is an independent marker of risk.

Methods

A total of 37,025 consecutive patients from the large ongoing prospective Intermountain Heart Collaborative Study database were evaluated and followed up for a mean of 5 years for the development of AF and dementia. Dementia was sub-typed into vascular (VD), senile (SD), Alzheimer's (AD), and nonspecified (ND).

Results

Of the 37,025 patients with a mean age of 60.6 ± 17.9 years, 10,161 (27%) developed AF and 1,535 (4.1%) developed dementia (179 VD, 321 SD, 347 AD, 688 ND) during the 5-year follow-up. Patients with dementia were older and had higher rates of hypertension, coronary artery disease, renal failure, heart failure, and prior strokes. In age-based analysis, AF independently was significantly associated with all dementia types. The highest risk was in the younger group (<70). After dementia diagnosis, the presence of AF was associated with a marked increased risk of mortality (VD: hazard ratio [HR] = 1.38, P = .01; SD: HR = 1.41, P = .001; AD: HR = 1.45; ND: HR = 1.38, P <.0001).

Conclusion

AF was independently associated with all forms of dementia. Although dementia is strongly associated with aging, the highest risk of AD was in the younger group, in support of the observed association. The presence of AF also identified dementia patients at high risk of death.

Section snippets

Methods

We examined the Intermountain Heart Collaborative Study database to examine an association of AF and dementia.28 This database includes all patients who receive care within the Intermountain Healthcare system and were seen by cardiologists with consent to participate in research. The population studied as noted in the prior publications is predominantly white (89%), with other races as follows: Hispanic 7%, Polynesian/Asian 1%, black 2%, and Native American 1%. We studied 37,026 consecutive

Results

Of the 37,025 patients with a mean age of 60.6 ± 17.9 years studied, 10,161 (27%) developed AF and 1,535 developed (4.1%) dementia (179 VD, 321 SD, 347 AD, 688 ND) during the 5-year follow-up. The basic demographics of the patient population listed and compared by AF status are shown in Table 1. Patients with AF were older and had higher rates of hypertension, coronary artery disease, renal failure, heart failure, and prior strokes. Statin use was similar between the groups. On average, the

Discussion

AF was independently associated with risk of all forms of dementia. Although dementia is strongly associated with aging, the highest risk of AD was in the younger AF group, in support of the observed association. The presence of AF in all dementia subtypes identified patients at higher risk of mortality. This mortality risk was most prominent in the youngest population studied.

Age remains the strongest risk factor for dementia, particularly for AD.3 In a community-based study, the estimated

Conclusion

AF was independently associated with all forms of dementia. Although dementia is strongly associated with aging, the highest risk of AD was in the younger group, in support of the observed association. The presence of AF also identified dementia patients at high risk of death. These findings require further investigation and confirmation in an effort to understand and prevent dementia as well as to optimally manage dementia patients at higher risk of adverse outcomes.

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    Drs. Bunch, Weiss, Crandall, and Osborn have received speaker's honorarium (minor) from Boston Scientific. Dr. Day is a consultant (minor) for Boston Scientific and St. Jude Medical.

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