Clinical InvestigationAtrial fibrillation incrementally increases dementia risk across all CHADS2 and CHA2DS2VASc strata in patients receiving long-term warfarin
Graphical abstract
Section snippets
Methods
Patients that were ≥18 years of age, had no history of dementia, and were chronically anticoagulated with warfarin with >1 international normalized ratio measurement (target international normalized ratio of 2-3) for thromboembolism prevention between January 1, 1997, and February 18, 2015, were studied. Patients were analyzed in 2 groups; the first group was patients who were anticoagulated with warfarin for stroke prevention due to AF; the second group was patients using long-term warfarin
Results
The baseline demographics of the overall population stratified by AF and non-AF patients receiving long-term warfarin for thromboembolism prevention are shown in Table I.
Distribution among CHADS2 risk strata was similar among non-AF and AF patients. Results were similar when evaluating by CHA2DS2Vasc strata; however, non-AF indication for warfarin was more prevalent with increasing score (Supplemental Table 1).
A total of 79 (2.6%) non-AF and 156 (5.2%) AF patients developed dementia during 7.7 ±
Discussion
We observed that dementia rates increase as CHADS2 and CHA2DS2VASc scores increase among all patients receiving long-term warfarin. This finding suggests that, in most patients, dementia, similar to AF, may be an end manifestation of a systemic disease state reflecting multiple cardiovascular risk factors. Patients with elevated CHADS2 or CHA2DS2VASc scores have an increased risk of dementia. The presence of AF added additional risk to the various strata for CHADS2 and CHA2DS2VASc scores. This
Limitations
This is a retrospective, observational study that used a large electronic database warehouse to query the clinical data pertinent for the purpose of identifying relations relevant to this study. There were lower event rates among non-AF patients compared with AF patients; therefore, associations were not always significant. This study relies on physicians to diagnose and document patient diseases with the appropriate ICD-9 and ICD-10 codes. Therefore, there is a risk of disease
Conclusion
In patients who are anticoagulated long term on warfarin, the presence of AF was associated with higher rates and increased risk of dementia across all CHADS2 score strata. Furthermore, escalating CHADS2 scores showed that dementia risk was increased for all patients anticoagulated long term on warfarin. The results of this study highlight that dementia is often an end manifestation of a systemic disease state that is driven by multiple comorbidities and that AF is additive to this process and
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