Chiara Melloni1,2, Peter Shrader2, Joseph Carver3, Jonathan P Piccini1,2, Laine Thomas2, Gregg C Fonarow4, Jack Ansell5, Bernard Gersh6, Alan S Go7, Elaine Hylek8, Irving M Herling9, Kenneth W Mahaffey10, Anthony F Yu11, Eric D Peterson1,2, Peter R Kowey12. 1. Duke University Medical Center, DCRI, North Pavilion, 2400 Pratt Street, Durham, NC 27705, USA. 2. Duke Clinical Research Institute, DCRI, North Pavilion, 2400 Pratt Street, Durham, NC 27705, USA. 3. Division of Cardiology, Abramson Cancer Center, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA. 4. UCLA Division of Cardiology, 10833 Le Conte Ave, CHS BH 307, Los Angeles, CA 90095, USA. 5. Lenox Hill Hospital, New York University School of Medicine, 6 Blackhall 100 East 77th Street, New York, NY 10075, USA. 6. Mayo Clinic College of Medicine, 200 First Street, SW Gonda 5-368 Rochester, MN 55905, USA. 7. Division of Research, Kaiser Permanente of Northern California 2000 Broadway Street, Oakland, CA, USA. 8. Boston University Medical Center, Research Unit-Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA. 9. The Heart Institute at Lankenau Medical Center, Lankenau MOB, 100 Lancaster Avenue, Wynnewood, PA 19096, USA. 10. Department of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA. 11. Memorial Sloan Kettering Cancer Center, 885 2nd Ave New York, NY 10017, USA. 12. MLH Heart Center, Lankenau MOB, 100 Lancaster Avenue, Wynnewood, PA 19096, USA.
Abstract
Aims: The presence of cancer can complicate treatment choices for patients with atrial fibrillation (AF) increasing both the risk of thrombotic and bleeding events. Methods and results: Using data from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we aimed to characterize AF patients with cancer, to describe their management and to assess the association between cancer and cardiovascular (CV) outcomes. Among 9749 patients, 23.8% had history of cancer (57% solid malignancy, 1.3% leukaemia, 3.3% lymphoma, 40% other type, and 2.2% metastatic cancer). Patients with history of cancer were older, more likely to have CV disease, CV risk factors, and prior gastrointestinal bleeding. No difference in antiarrhythmic and antithrombotic therapy was observed between those with and without cancer. Patients with history of cancer had a significantly higher risk of death (7.8 vs. 4.9 deaths per 100 patient-years follow-up, P = 0.0003) mainly driven by non-CV death (4.2 vs. 2.4 per 100 patient-years follow-up; P = 0.0004) and higher risk of major bleeding (5.1 vs. 3.5 per 100 patient-years follow-up; P = 0.02) compared with non-cancer patients; no differences were observed in risks of strokes/non-central nervous system embolism (1.96 vs. 1.48, P = 0.74) and CV death (2.89 vs. 2.07, P = 0.35) between the two groups. Conclusion: A history of cancer is common among AF patients with up to one in four patients having both. Antithrombotic therapy, rates of cerebrovascular accident, other thrombotic events and cardiac death were similar in AF patients with or without a history of cancer. Patients with cancer, however, were at higher risk of major bleeding and non-CV death. Published on behalf of the European Society of Cardiology. All rights reserved.
Aims: The presence of cancer can complicate treatment choices for patients with atrial fibrillation (AF) increasing both the risk of thrombotic and bleeding events. Methods and results: Using data from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we aimed to characterize AFpatients with cancer, to describe their management and to assess the association between cancer and cardiovascular (CV) outcomes. Among 9749 patients, 23.8% had history of cancer (57% solid malignancy, 1.3% leukaemia, 3.3% lymphoma, 40% other type, and 2.2% metastatic cancer). Patients with history of cancer were older, more likely to have CV disease, CV risk factors, and prior gastrointestinal bleeding. No difference in antiarrhythmic and antithrombotic therapy was observed between those with and without cancer. Patients with history of cancer had a significantly higher risk of death (7.8 vs. 4.9 deaths per 100 patient-years follow-up, P = 0.0003) mainly driven by non-CV death (4.2 vs. 2.4 per 100 patient-years follow-up; P = 0.0004) and higher risk of major bleeding (5.1 vs. 3.5 per 100 patient-years follow-up; P = 0.02) compared with non-cancerpatients; no differences were observed in risks of strokes/non-central nervous system embolism (1.96 vs. 1.48, P = 0.74) and CV death (2.89 vs. 2.07, P = 0.35) between the two groups. Conclusion: A history of cancer is common among AFpatients with up to one in four patients having both. Antithrombotic therapy, rates of cerebrovascular accident, other thrombotic events and cardiac death were similar in AFpatients with or without a history of cancer. Patients with cancer, however, were at higher risk of major bleeding and non-CV death. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Wesley T O'Neal; J'Neka S Claxton; Pratik B Sandesara; Richard F MacLehose; Lin Y Chen; Lindsay G S Bengtson; Alanna M Chamberlain; Faye L Norby; Pamela L Lutsey; Alvaro Alonso Journal: J Am Coll Cardiol Date: 2018-10-16 Impact factor: 24.094
Authors: Bhautesh Dinesh Jani; Barbara I Nicholl; Ross McQueenie; Derek T Connelly; Peter Hanlon; Katie I Gallacher; Duncan Lee; Frances S Mair Journal: Europace Date: 2018-11-01 Impact factor: 5.214
Authors: E Venturini; G Iannuzzo; A D'Andrea; M Pacileo; L Tarantini; M L Canale; M Gentile; G Vitale; F M Sarullo; R Vastarella; A Di Lorenzo; C Testa; A Parlato; C Vigorito; F Giallauria Journal: J Clin Med Date: 2020-06-10 Impact factor: 4.964