Prevalence, trends, and outcomes of atrial fibrillation in hospitalized patients with metastatic cancer: findings from a national sample

Abstract

Background Epidemiological evidence regarding the link between cancer and atrial fibrillation (AF) are limited and outcomes of metastatic cancer comorbid with AF need to be elucidated. Objective This study aims to evaluate the prevalence, temporal trends, and outcomes of AF in hospitalized metastatic cancer patients. Methods The National Inpatient Sample (NIS) database was used to identify adult patients with metastatic tumors from 2003 to 2014. We analyzed the trends in AF prevalence, in‐hospital mortality, total cost, length of stay (LOS), and comorbidities pertaining to metastatic cancer. Multivariable‐adjusted models were used to evaluate the association of AF with clinical factors, in‐hospital mortality, total cost, and LOS. Results Among 2,478,598 patients with metastatic cancer, 8.74% (216,737) were diagnosed with AF. The proportion of comorbid AF increased from 8.28% in 2003 to 10.06% in 2014 (p < 0.0001). Older age, white race, male, Medicare, higher income, larger hospital bed size, and urban teaching hospital were associated with higher AF occurrence. Among primary tumor sites, lung cancer experienced the highest odds of AF compared to other cancers. Patients with metastasis to lymph node and respiratory organ had higher odds of AF. In metastatic cancer, AF was associated with higher in‐hospital mortality (odds ratio: 1.48; 95% confidence interval: 1.43–1.54), 18% longer LOS, and 19% higher cost. Conclusions AF prevalence in metastatic cancer continues to increase from 2003 to 2014. AF is linked to poorer prognosis and higher healthcare resource utilization. As the population ages, optimal preventive and treatment management strategies are needed for metastatic cancer comorbid with AF.

Current Data and Future Perspectives on Patients with Atrial Fibrillation and Cancer

“…The improvement in cancer patients' prognoses and therefore the aging of this population, as well as the introduction of targeted therapies, have exponentially increased the incidence of cardiac arrhythmias seen in oncology and hematology wards [1][2][3]. In particular, AF, a leading cause of thrombotic morbidity and overall cardiovascular (CV) mortality, is the most common sustained arrhythmia in the general population and has been revealed to be more common in patients with malignancies [1][2][3][4], reaching an incidence of 30% in the available studies [5][6][7][8]. In this setting, the prevalence seems extremely variable in the literature, depending on the age of the population examined, pre-existing risk factors, the type of primitive cancer, previous oncologic surgery, and the chemotherapy schemes instituted [9][10][11][12][13].…”

“…Indeed, the risk of AF is higher in subjects older than 65 years with known CV disease [14], as well as in those patients affected by all hematologic malignancies, including lymphoma, leukemia, and multiple myeloma, rather than solid tumors [15]. Moreover, higher cancer stages and grades at diagnosis raise the risk of AF, even suggesting a systemic effect of advanced cancer itself on the heart [7]. Of importance, post-operative AF is the most frequent form of sustained arrhythmia in cancer patients.…”

Outcomes and Discriminatory Accuracy of the CHA2DS2VASc Score in Atrial Fibrillation and Cancer

“…Moreover, while some studies have linked new-onset AF in cancer patients with poor in-hospital outcomes, there has been no study specifically addressing the risk of major outcomes such as stroke, major bleeding, or all-cause readmission of cancer patients at 30 days. 7 To bridge this knowledge gap, the current study aimed to identify the impact of AF on the risk of developing ischemic stroke and major bleeding at 30 days among the most common cancer types stratified by CHA 2 DS 2 VASc score. Furthermore, the predictive ability of different CHA 2 DS 2 VASc categories for stroke risk discrimination among cancer types was also explored.…”

Caught Between a Rock and a Hard Place

“… 1 , 2 However, the utility of this score in predicting ischemic stroke in AF patients with active cancer has not been validated. 3 , 4 Cancer presents a clinical dilemma as it increases the risk of both thrombosis (ischemic stroke) and bleeding. 5 , 6 The causes of thrombosis include cancer-related hypercoagulability, noninfectious endocarditis, paradoxical embolization of cancer-related clots, and tumor occlusion.…”