Synergistic effect of early rhythm control and healthy lifestyle on the risk of dementia in patients with new-onset atrial fibrillation

Abstract Background Early rhythm control (ERC) and healthy lifestyle (HLS) have been found to be related to lower dementia risk in patients with atrial fibrillation (AF), however, it has not been evaluated whether there is a synergistic effect between the two. Methods Using the Korean National Health Insurance Service database, patients who were newly diagnosed with AF between 2009 and 2016. Patients were categorized as follows: those who did not receive ERC including antiarrhythmic drug, cardioversion, AF catheter ablation within 2-year after AF diagnosis, and had 1 or more unhealthy lifestyle behaviors among current drinking, current smoking, and lack of regular exercise (group 1), those with HLS, but not receiving ERC (group 2), those receiving ERC, but with at least 1 unhealthy lifestyle behavior (group 3), and those with HLS and receiving ERC (group 4). To compare 4 groups, propensity score weighting method was used to balance the baseline characteristics of 4 groups. During follow-up, incident dementia, vascular dementia, and Alzheimer’s dementia were evaluated. Results A total of 199,947 patients were included. The mean time from AF diagnosis to implementation of ERC of groups 3 and 4 was 27±77 and 27±74 days, respectively. Among total study population, 96,907, 53,293, 29,234, and 20,513 patients were included in group 1, 2, 3, and 4, respectively. Group 4 showed the greatest risk reduction for all dementia, vascular dementia, and Alzheimer’s dementia among 4 groups (Figure). Both ERC alone and HLS alone were associated with a lower risk of vascular dementia by 20% than group 1. The combination of the two was associated with a lower risk of vascular dementia by 40% (Figure). However, the impact of ERC on the risk reduction of Alzheimer’s dementia was statistically insignificant, and maintaining HLS seemed sufficient to lower the risk of Alzheimer’s dementia (Figure). Conclusion The combination of ERC and HLS might be beneficial to prevent vascular dementia in patients with new-onset AF. To reduce the risk of Alzheimer’s dementia, maintaining HLS should be emphasized.