Lower risk of dementia with early rhythm control therapy and a healthy lifestyle in patients with new-onset atrial fibrillation

초록

BACKGROUND: Atrial fibrillation (AF) is an independent risk factor for dementia. OBJECTIVE: The purpose of this study was to investigate the association of combining early rhythm control (ERC) and a healthy lifestyle (HLS) with the risk of incident dementia in patients with new-onset AF. METHODS: The Korean National Health Insurance Service database included patients newly diagnosed with AF between 2009 and 2016. Patients were classified into 4 groups: those without ERC or HLS (group 1), those with HLS alone (group 2), those with ERC alone (group 3), and those with both ERC and HLS (group 4). The propensity score weighting method was used to balance baseline characteristics among the 4 groups. Incidental dementia was evaluated during follow-up. RESULTS: A total of 199,947 patients were included (96,907, 53,293, 29,234, and 20,513 in groups 1, 2, 3, and 4, respectively). Compared with group 1, group 4 showed the lowest risk of all dementia subtypes (weighted hazard ratio, 95% confidence interval 0.691, 0.649-0.735), followed by group 2 (0.754, 0.725-0.785) and group 3 (0.919, 0.876-0.964). For vascular dementia, group 4 had the lowest risk compared with group 1 (0.598, 0.507-0.705) whereas group 2 (0.802, 0.728-0.882) and group 3 (0.803, 0.708-0.911) showed similar risks. For Alzheimer dementia, group 4 showed the lowest risk (0.728, 0.680-0.780), followed by group 2 (0.747, 0.715-0.782). In contrast, group 3 showed a comparable risk (0.958, 0.908-1.010) to group 1. CONCLUSIONS: A combination of ERC and HLS might mitigate the risk of dementia in patients with new-onset AF. These findings support a holistic approach to preventing dementia in this population. Copyright © 2026 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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