Abstract
Background: Atrial fibrillation (AF) is a risk factor for cerebrovascular diseases and vascular dementia (VAD). The aim of this study was to evaluate the effect of the adherence to anticoagulant therapy guidelines in patients with dementia and AF on the risk of stroke/TIA or major bleeding (MB). Methods: In a cohort of 1705 hospitalized patients with pre-existent AF, we observed 193 patients with vascular dementia (VAD). Non-demented AF patients were included as controls. For each subject, we calculated CHA2DS2-VASc, CHADS2, and HAS-BLED scores, and collected information regarding anticoagulant therapy, in-hospital therapeutic failure (TF) occurrence, stroke/TIA, and MB. Results: According to CHA2DS2-VASc and CHADS2 scores, 99.5% of VAD patients had the indication to anticoagulant treatment, but only 69.9% were correctly treated. During hospitalization, MB occurred in 4.66% of VAD and 8.9% of non-demented patients (p = 0.048). In-hospital stroke/TIA were observed in 24.3% of VAD and 0.8% of non-demented patients (p = 0.0001). A similar proportion of TF among patients with VAD and with normal cognition (12.9% vs. 11.2%) was observed. Conclusion: In our cohort, we observed that VAD patients with pre-existent AF were undertreated despite a higher risk of stroke/TIA with respect to non-demented patients.
Highlights
Vascular dementia (VAD) is usually associated with several vascular risk factors such as hypertension, insulin resistance, diabetes, obesity, hyperhomocysteinemia, and dyslipidemia [1,2,3].Recent evidence shows a narrow relationship between atrial fibrillation (AF) and different types of dementia [4,5,6]
We evaluated in-hospital death or intensive care unit (ICU) transfer, which were synthesized as a binary variable named therapeutic failure (TF)
We obtained a final sample of 1705 consecutive patients admitted to the stepdown unit (SDU) of our hospital and affected by pre-existing Atrial fibrillation (AF)
Summary
Vascular dementia (VAD) is usually associated with several vascular risk factors such as hypertension, insulin resistance, diabetes, obesity, hyperhomocysteinemia, and dyslipidemia [1,2,3].Recent evidence shows a narrow relationship between atrial fibrillation (AF) and different types of dementia [4,5,6]. Several studies showed that cognitive decline in AF patients is mainly associated with silent cerebral infarctions due to a probably undetected embolic mechanism [4,9]. Another possible pathogenic hypothesis concerns a reduced cerebral blood flow for a lowered cardiac output with a consequent chronic cerebral hypoperfusion [4,10]. Atrial fibrillation (AF) is a risk factor for cerebrovascular diseases and vascular dementia (VAD). The aim of this study was to evaluate the effect of the adherence to anticoagulant therapy guidelines in patients with dementia and AF on the risk of stroke/TIA or major bleeding (MB)
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