Risk of Incident Atrial Fibrillation and Subsequent Use of Oral Anticoagulants in Patients with Dementia

BACKGROUND Dementia and atrial fibrillation (AF) have many shared risk factors. There are limited data on the risks of incident AF and AF-related clinical outcomes in patients with dementia. METHODS Out study utilized the Taiwan National Health Insurance Research Database. A total of 544,074 patients with dementia were compared to 554,074 age- and sex-matched patients without dementia regarding the risk of incident AF. Among patients with dementia who experienced incident AF, the risks of clinical events of patients treated with warfarin or NOACs were compared to those without OACs. RESULTS The risk of incident AF was greater for patients with dementia compared to those without (1.89 vs 1.78 per 100 person-years). Among patients with dementia and experienced incident AF, warfarin use was associated with a higher risk of ischemic stroke (aHR 1.290; 95%CI 1.156-1.440), intracranial hemorrhage (ICH)(aHR 1.678; 95%CI 1.346-2.090) and major bleeding (aHR 1.192; 95%CI 1.073-1.323) compared to non-OACs. NOAC use was associated with a lower risk of ischemic stroke (aHR 0.421; 95%CI 0.352-0.503) and composite risk of ischemic stroke or major bleeding (aHR 0.544; 95%CI 0.487-0.608) compared to non-OACs. These results were consistent among the patients after the propensity matching. CONCLUSIONS In this nationwide cohort, the risk of incident AF was higher in patients with dementia. For patients with dementia who experienced incident AF, NOAC use was associated with better clinical outcomes compared to non-OAC. Patients with dementia require a holistic approach to their care and management, including the use of NOACs to reduce risks of clinical events.

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