Article Text

Original research
Anticoagulant prescribing for atrial fibrillation and risk of incident dementia
  1. Sharon Louise Cadogan,
  2. Emma Powell,
  3. Kevin Wing,
  4. Angel Yun Wong,
  5. Liam Smeeth,
  6. Charlotte Warren-Gash
  1. Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  1. Correspondence to Dr Charlotte Warren-Gash, Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; charlotte.warren-gash1{at}lshtm.ac.uk

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).

https://creativecommons.org/licenses/by/4.0/

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/.

Statistics from Altmetric.com

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).

View Full Text

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles