Lower Risk of Dementia with Early Rhythm Control Therapy and a Healthy Lifestyle in Patients with New-Onset Atrial Fibrillation.

BACKGROUND: Atrial fibrillation (AF) is an independent risk factor for dementia. OBJECTIVE: To investigate the association of combining early rhythm control (ERC) and 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 four groups: those without ERC or HLS (group 1), those with HLS only (group 2), those with ERC only (group 3), and those with both ERC and HLS (group 4). The propensity score weighting method was used to balance baseline characteristics among the four 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 to group 1, group 4 showed the lowest risk for all dementia (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 to 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's 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. CONCLUSION: 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.