Prevalence and prognostic value of dementia in atrial fibrillation patients in emergency departments: Insights from a national-wide multicenter registry study.

Introduction: Atrial fibrillation (AF) and dementia are two common comorbidities in emergency departments (ED) that can significantly affect patients' quality of life. The aim of this study was to evaluate the prevalence and long-term impact of dementia on survival in patients with AF.

Methods: We conducted a multicenter prospective observational study and consecutively recruited 2016 AF patients from 20 hospitals in China. The primary endpoint was all-cause mortality and the secondary endpoint was stroke. Multivariate logistic regression and odds ratio (OR) were used to identify clinical factors associated with AF patients with dementia. Four multivariate adjusted Cox proportional hazard models were conducted to evaluate the risk factors associated with endpoints.

Results: Totally, 2.2 % of AF patients were found to have dementia in ED. Older age (OR 1.05, 95 % CI 1.02-1.09, P = 0.005), coronary artery disease (OR 2.61, 95 % CI 1.21-6.05, P = 0.019), previous stroke or transient ischemic attack (TIA) (OR 5.67, 95 %CI 2.92-11.26, P < 0.001) and prior major bleeding (OR 3.89, 95 %CI 1.11-11.49, P = 0.021) were independent risk factors for patients with both AF and dementia. During one-year follow-up, Log-rank analysis presented that dementia decreased overall survival (P < 0.001) and had a higher incidence of stroke (P < 0.001). After adjusting age, body mass index, blood pressure, type of AF, comorbidities and treatments, multivariate Cox models showed that dementia was independently associated with increased mortality and increasing risk of stroke.

Conclusions: Dementia significantly affects the survival and stroke incidence in AF patients. Prioritizing cognitive function screening and comprehensive care in ED is crucial for managing AF effectively.