Management and outcomes of patients with atrial fibrillation and a history of cancer: The ORBIT-AF registry

Chiara Melloni, Peter Shrader, Joseph Carver, Jonathan P. Piccini, Laine Thomas, Gregg C. Fonarow, Jack Ansell, Bernard Gersh, Alan S. Go, Elaine Hylek, Irving M. Herling, Kenneth W. Mahaffey, Anthony F. Yu, Eric D. Peterson, Peter R. Kowey

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)192-197
Number of pages6
JournalEuropean Heart Journal - Quality of Care and Clinical Outcomes
Volume3
Issue number3
DOIs
StatePublished - Jul 2017
Externally publishedYes

Keywords

  • Anticoagulant therapy
  • Atrial fibrillation
  • Cancer

ASJC Scopus subject areas

  • Health Policy
  • Cardiology and Cardiovascular Medicine

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