Definition for your questions to your doctor: Early rhythm control - Treatment with an antiarrhythmic medication or AF ablation, and cardioversion of persistent AF. You don't want to get dementia so you better hope your competent? doctor has EXACT PROTOCOLS to prevent that!
Early Rhythm Control and Incident Dementia in Patients With Atrial Fibrillation and Prior Stroke
Original Research
Central Illustration
Abstract
Background
Although early rhythm control (ERC) in patients with atrial fibrillation (AF) reduces the risk of stroke, there is no evidence thus far on whether ERC reduces the risk of developing dementia in patients with AF and prior stroke.
Objectives
This study sought to evaluate whether ERC reduces the risk of developing dementia in patients with new-onset AF and prior stroke.
Methods
Using the Korean nationwide claims database, we identified patients with new-onset AF and prior stroke between 2010 and 2016. Patients who received rhythm control therapy within 1 year after AF onset were defined as the ERC group, otherwise patients were categorized as the usual care group. A propensity score weighting method was used to balance the 2 groups. Incident dementia defined by relevant diagnostic codes was evaluated.
Results
A total of 41,370 patients were included (mean age 70 ± 11 years; mean CHA2DS2-VASc score 5.3±1.6): 10,213 in the ERC group and 31,157 in the usual care group. Compared with usual care, ERC was associated with lower risks of all dementia, Alzheimer’s dementia, and vascular dementia (weighted HRs [95% CIs], 0.825 [0.776-0.876], 0.831 [0.774-0.893], and 0.800 [0.702-0.913], respectively, all P < 0.001). The benefit of ERC was slightly accentuated in the younger age group (<65 years). The beneficial effect of ERC in reducing the risk of dementia was consistent regardless of the characteristics of prior stroke.
Conclusions
ERC might be beneficial in the prevention of dementia in patients with AF and prior stroke. To prevent the progression of cognitive dysfunction, ERC should be considered in this population.
Introduction
Stroke results in cognitive impairment along with physical disability, which significantly impacts the quality of life of stroke survivors.1 Poststroke dementia is common after stroke with prevalence ranging from 10% to 50%.2-5 The incidence of poststroke dementia is higher in the first few months after stroke.6 Although the relative risk of dementia after stroke progressively declines, more than 20% of patients who experience stroke develop dementia within 4 years after stroke.7 The prevalence of dementia in patients with prior stroke is similar to that observed in individuals 10 years older without prior stroke, thus, such patients are considered to be at high risk for dementia.8 Appropriate strategies to reduce the risk of future dementia are required.
Atrial fibrillation (AF) increases the risk of dementia and stroke in the general population.9,10 In addition, AF detected after stroke is an independent risk factor for dementia.11 Previous observational studies have suggested that rhythm control in patients with AF might reduce the risk of cognitive impairment and dementia.12-14 Previously, the benefits of AF rhythm control by antiarrhythmic drugs (AADs) and catheter ablation in the prevention of stroke have been controversial.15,16 A recent clinical trial has demonstrated that implementing early rhythm control (ERC) within 1 year after AF onset significantly reduces the risk of stroke in patients with AF.17 However, there is still a lack of evidence on whether ERC reduces the risk of developing dementia in patients with AF and prior stroke.
In this study, we aimed to evaluate whether ERC reduces the risk of developing dementia in patients with new-onset AF and a history of stroke.
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