Risk of dementia in patients with atrial fibrillation: Short versus long follow-up. A systematic review and meta-analysis.

ABSTRACT

BACKGROUND: No previous meta-analyses have compared the risk of dementia, due to an underlying atrial fibrillation (AF), in the short-term versus the long-term period. AIM: To perform an update meta-analysis of studies examining the association between AF and dementia and the relative impact of follow-up period. METHODS: Data were obtained searching MEDLINE and Scopus for all investigations published between 1 January 2000 and March 1, 2021 reporting the risk of dementia in AF patients. The following MeSH terms were used for the search "Atrial Fibrillation" AND "Dementia" OR "Alzheimer's disease". From each study, the adjusted hazard ratio (aHR) with the related 95% confidence interval (CI) was pooled using a random effect model. RESULTS: The analysis was carried out on 18 studies involving 3.559.349 subjects, of which 902.741 (25.3%) developed dementia during follow-up. A random effect model revealed an aHR of 1.40 (95% CI 1.27-1.54, p < 0.0001; I2  = 93.5%) for dementia in subjects with AF. Stratifying the studies according to follow-up duration, those having a follow-up ≥10 years showed an aHR for dementia of 1.37 (95% CI 1.21-1.55, p < 0.0001, I2  = 96.6%), while those with a follow-up duration <10 years has a slightly higher aHR for dementia (HR 1.59, 95%CI 1.51-1.67, p < 0.0001, I2  = 49%). Nine studies showed that the aHR for Alzheimer's disease (AD) in AF patients was 1.30 (95%CI 1.12-1.51, p < 0.0001, I2  = 87.6%). CONCLUSIONS: Evidence suggests that patients with AF have an increased risk of developing dementia and AD. The risk of dementia was slightly higher when the follow-up was shorter than 10 years.