Rhythm Control Better Prevents Dementia than Rate Control Strategies in Patients with Atrial Fibrillation—A Nationwide Cohort Study

Jiunn Cherng Lin, Cheng Hung Li, Yun Yu Chen, Chi Jen Weng, Yu Shan Chien, Shang Ju Wu, Chu Pin Lo, Hui Chun Tien, Ching Heng Lin, Jin Long Huang, Yenn Jiang Lin, Yu Cheng Hsieh*, Shih Ann Chen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Atrial fibrillation (AF) increases the risk of dementia. Whether the pharmacological rhythm control of AF can reduce the risk of dementia compared to the rate control strategy remains unclear. We hypothesize that the rhythm control strategy is better than the rate control strategy in preventing dementia. Methods: AF patients aged ≥65 years were identified from the Taiwan National Health Insurance Database. Patients receiving anti-arrhythmic drugs at a cumulative defined daily dose (cDDD) of >30 within the first year of enrollment constituted the rhythm control group. Patients who used rate control medications for a cDDD of >30 constituted the rate control group. A multivariate Cox hazards regression model was used to determine the hazard ratio (HR) for dementia. Results: A total of 3382 AF patients (698 in the rhythm control group; 2684 in the rate control group) were analyzed. During a 4.86 ± 3.38 year follow-up period, 414 dementia events occurred. The rhythm control group had a lower rate of dementia than the rate control group (adjust HR: 0.75, p = 0.031). The rhythm control strategy reduced the risk of dementia particularly in those receiving aspirin (p = 0.03). Conclusions: In patients with AF, pharmacological rhythm control was associated with a lower risk of dementia than rate control over a long-term follow-up period, particularly in patients receiving aspirin treatment.

Original languageEnglish
Article number572
JournalJournal of Personalized Medicine
Volume12
Issue number4
DOIs
StatePublished - Apr 2022

Keywords

  • atrial fibrillation
  • dementia
  • rate control
  • rhythm control
  • stroke

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