Abstract 15920: Atrial Fibrillation is Associated With Higher Rates of Dementia in Patients Anticoagulated With Warfarin
Introduction: Patients with atrial fibrillation (AF) are at higher risk for developing dementia, particularly those exposed to broad fluctuations in anticoagulant therapy. Warfarin is a common therapy for the prevention of thromboembolism in AF, valve replacement, and thrombosis patients. The extent to which AF increases dementia risk across all CHADS2 risk strata independent of anticoagulation strategy is unknown.
Methods: A total 6,030 patients with no history of any dementia and chronically anticoagulated with warfarin for any indication were studied. Warfarin management was provided through a Clinical Pharmacy Anticoagulation Service (CPAS). Patients were separated by warfarin indication of AF (n=3,015) and non-AF (n=3,015) and matched by propensity score (±0.01). At the time of warfarin initiation, patients were stratified by CHADS2 scores and followed for incident dementia.
Results: The average age of the AF cohort was 69.3±11.2 years and 52.7% were male, while non-AF cohort was 69.3±10.9 years and 51.5% were male. Increasing CHADS2 score was associated with increased dementia diagnosis: 0 (n=917) =2.2%, 1 (n=1,773) =3.9%, 2 (n=1,813) =3.6%, 3 (n=1,527) = 5.6% and ≥4 (n=527) =4.4%, p-trend=0.004. When stratifying by CHADS2 score, AF patients had an increased risk of dementia incidence (non-AF vs. AF): 0: 2.4% vs. 1.9%, p=0.61; 1: 3.1% vs. 4.8%, p=0.06; 2: 2.2% vs. 5.1%, p=0.001; 3: 3.0% vs. 8.1%, p<0.0001; and ≥4: 2.3% vs. 6.4%, p=0.02. Even after multivariate adjustment, AF patients continued to display a significantly increased risk of dementia when compared to matched non-AF patients (Figure).
Conclusion: In patients anticoagulated with warfarin, the presence of AF was associated with higher rates of dementia across all CHADS2 score strata. These data show the independent risk of AF for dementia across multiple disease states that predispose towards cognitive decline.
Author Disclosures: K.G. Graves: None. H.T. May: None. V. Jacobs: None. T.L. Bair: None. B.G. Crandall: None. M. Cutler: None. C. Mallender: None. J.S. Osborn: None. J.P. Weiss: None. J.D. Day: None. T.J. Bunch: None.
- © 2016 by American Heart Association, Inc.