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Abstract
Objective The aim of this study was to investigate the association between oral anticoagulant type (direct oral anticoagulants (DOACs) vs vitamin K antagonists (VKAs)) and incident dementia or mild cognitive impairment (MCI) among patients with newly diagnosed atrial fibrillation (AF).
Methods Using linked electronic health record (EHR) data from the Clinical Practice Research Datalink in the UK, we conducted a historical cohort study among first-time oral anticoagulant users with incident non-valvular AF diagnosed from 2012 to 2018. We compared the incidence of (1) clinically coded dementia and (2) MCI between patients prescribed VKAs and DOACs using Cox proportional hazards regression models, with age as the underlying timescale, accounting for calendar time and time on treatment, sociodemographic and lifestyle factors, clinical comorbidities and medications.
Results Of 39 200 first-time oral anticoagulant users (44.6% female, median age 76 years, IQR 68–83), 20 687 (53%) were prescribed a VKA and 18 513 (47%) a DOAC at baseline. Overall, 1258 patients (3.2%) had GP-recorded incident dementia, incidence rate 16.5 per 1000 person-years. DOAC treatment for AF was associated with a 16% reduction in dementia diagnosis compared with VKA treatment in the whole cohort (adjusted HR 0.84, 95% CI: 0.73 to 0.98) and with a 26% reduction in incident MCI (adjusted HR 0.74, 95% CI: 0.65 to 0.84). Findings were similar across various sensitivity analyses.
Conclusions Incident EHR-recorded dementia and MCI were less common among patients prescribed DOACs for new AF compared with those prescribed VKAs.
- atrial fibrillation
- dementia
- DOACs
- vitamin K antagonists
- electronic health records
Data availability statement
This study utilises data from the Clinical Practice Research Datalink, obtained under licence from the UK Medicines and healthcare products regulatory agency. The data is provided by patients and collected by the NHS as part of their care and support. The interpretation and conclusions contained in this study are those of the author/s alone. The data used in this study can only be used for the purposes set out in the submitted and approved ISAC protocol. no data can, therefore, be archived by the research team. Any future research would require a new application to CPRD with data obtained directly from CPRD, subject to their policies for scientific, data governance, and financial approvals (see www.cprd.com).
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
This study utilises data from the Clinical Practice Research Datalink, obtained under licence from the UK Medicines and healthcare products regulatory agency. The data is provided by patients and collected by the NHS as part of their care and support. The interpretation and conclusions contained in this study are those of the author/s alone. The data used in this study can only be used for the purposes set out in the submitted and approved ISAC protocol. no data can, therefore, be archived by the research team. Any future research would require a new application to CPRD with data obtained directly from CPRD, subject to their policies for scientific, data governance, and financial approvals (see www.cprd.com).
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Footnotes
Contributors CW-G, KW, LS, AYW and EP contributed to the design of the study. SLC extracted the data and performed the statistical analysis. CW-G and SLC drafted the manuscript. All authors contributed to the interpretation of the data and the review of manuscript drafts, and all approved the final manuscript.
Funding This work was supported by Wellcome (Intermediate Clinical Fellowship 201440/Z/16/Z to CW-G).
Competing interests LS reports grants from Wellcome, Medical Research Council, National Institute of Health Research, Glaxo Smith Kline, the British Heart Foundation and Diabetes UK, outside the submitted work and is a Trustee of the British Heart Foundation. CW-G reports grants from Wellcome, during the conduct of the study and grants from British Heart Foundation and the Alzeinher’s Society, outside the submitted work. SLC, EP, AYW and KW have nothing to disclose.
Provenance and peer review Not commissioned; externally peer reviewed.
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