Association between dementia and left atrial appendage occlusion in patients with atrial fibrillation: A TriNetX-based retrospective cohort study with target trial emulation

Background: Atrial fibrillation (AF) is a common cardiac arrhythmia linked to an elevated risk of stroke and dementia. Emerging observational evidence suggests that left atrial appendage occlusion (LAAO) may reduce the risk of dementia in patients with AF; however, further research is required to confirm this potential benefit. Objective: This study aimed to compare the effectiveness of LAAO vs direct oral anticoagulants (DOACs) in reducing the risk of dementia in patients with AF. Methods: We conducted target trial emulation using data from the TriNetX research network. Patients with AF were allocated to 2 cohorts (2270 patients in each one), treated either with LAAO or with DOACs, and balanced with propensity score matching. The primary end points were composite dementia, vascular dementia, and Alzheimer disease. Secondary end points included mortality, ischemic stroke, intracranial hemorrhage, and major adverse cardiovascular events. Follow-up was conducted over 3 years. Results: At 3-year follow-up, the risk of composite dementia was lower in the LAAO group than in the DOAC group (hazard ratio 0.57; 95% confidence interval 0.38–0.85). Subgroup analyses demonstrated consistent results, favoring the LAAO group. No significant differences were observed in the incidence of secondary outcomes. Conclusion: This real-world study suggests that LAAO is associated with a lower risk of dementia in patients with AF compared with DOACs. Further prospective research with long-term follow-up is needed to validate our findings in the population with AF.