Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
ICES, Toronto, ON, Canada.
Europace. 2019 Dec 1;21(12):1793-1801. doi: 10.1093/europace/euz237.
Atrial fibrillation (AF) is a risk factor for dementia among ischaemic stroke patients in whom the AF was known before the stroke (KAF). Atrial fibrillation detected after stroke (AFDAS) has a different profile compared to KAF, including less frequent cardiovascular comorbidities and lower CHA2-DS2-VASC scores. Currently, it is unknown if AFDAS is also associated with increased dementia risk. We assessed the association between AFDAS and the incident risk of dementia. We also evaluated whether the use of oral anticoagulants (OAC) was associated with lower dementia risk among AFDAS patients.
In this cohort study, we classified 9791 first-ever ischaemic stroke patients from the Ontario Stroke Registry into four groups: (i) No AF, (ii) KAF, (iii) Inpatient AFDAS (diagnosed during admission), and (iv) Outpatient AFDAS (diagnosed after discharge). We used multivariable Cox proportional models to estimate hazard ratios (HR) for the association between AFDAS and incident dementia risk. Dementia was determined through administrative datasets based on previously validated algorithms. In adjusted analyses, the dementia risk was higher for inpatient AFDAS [HR 1.78, 95% confidence interval (CI) 1.51-2.10] and outpatient AFDAS (HR 1.74, 95% CI 1.47-2.05) relative to no AF. Oral anticoagulants use was associated with lower dementia risk among patients with inpatient AFDAS (HR 0.58, 95% CI 0.43-0.79) and outpatient AFDAS (HR 0.60, 95% CI 0.43-0.83).
Atrial fibrillation detected after stroke was independently associated with higher risk of dementia relative to no AF. Among patients with AFDAS, the use of OACs was associated with lower dementia risk.
心房颤动（AF）是已知存在于中风前（KAF）的缺血性中风患者发生痴呆的危险因素。中风后发现的心房颤动（AFDAS）与 KAF 相比具有不同的特征，包括较少的心血管合并症和较低的 CHA2-DS2-VASC 评分。目前，尚不清楚 AFDAS 是否也与痴呆风险增加有关。我们评估了 AFDAS 与痴呆发病风险之间的关联。我们还评估了在 AFDAS 患者中，口服抗凝剂（OAC）的使用是否与较低的痴呆风险相关。
在这项队列研究中，我们将安大略中风登记处的 9791 例首次缺血性中风患者分为四组：（i）无 AF，（ii）KAF，（iii）住院 AFDAS（在住院期间诊断）和（iv）门诊 AFDAS（在出院后诊断）。我们使用多变量 Cox 比例模型来估计 AFDAS 与新发痴呆风险之间的关联的风险比（HR）。痴呆症是通过基于先前验证算法的行政数据集确定的。在调整后的分析中，与无 AF 相比，住院 AFDAS（HR 1.78，95%置信区间（CI）1.51-2.10）和门诊 AFDAS（HR 1.74，95%CI 1.47-2.05）的痴呆风险更高。在住院 AFDAS（HR 0.58，95%CI 0.43-0.79）和门诊 AFDAS（HR 0.60，95%CI 0.43-0.83）患者中，OAC 的使用与痴呆风险降低相关。
与无 AF 相比，中风后发现的 AF 与痴呆风险增加独立相关。在 AFDAS 患者中，OAC 的使用与痴呆风险降低相关。
