Impact of timing of atrial fibrillation, CHA 2 DS 2 -VASc score and cancer therapeutics on mortality in oncology patients

• Published in: Open heart 2020-11, Vol.7 (2), p.e001412
• Main Authors: Hussain, Muzna, Misbah, Rabel, Donnellan, Eoin, Alkharabsheh, Saqer, Hou, Yuan, Cheng, Feixiong, Crookshanks, Michael, Watson, Chris J, Toth, Andrew J, Houghtaling, Penny, Moudgil, Rohit, Budd, G Thomas, Tang, W H Wilson, Kwon, Deborah H, Jaber, Wael, Griffin, Brian, Kanj, Mohamad, Collier, Patrick
• Format: Article
• Language: English
• ISSN: 2053-3624; 2053-3624
• DOI: 10.1136/openhrt-2020-001412

To investigate timing and age distribution of atrial fibrillation (AF) in selected oncology patients, and the impact of AF timing, CHA DS -VASc score and cancer therapeutics on mortality. This is a retrospective cohort study of oncology patients referred to the cardio-oncology service from 2011 to 2018 for echocardiographic cardiosurveillance and/or pre-existing cardiovascular risk factor/disease management. Rates of first AF diagnosis was assessed using a parametric multiphase hazard model (predictive modelling) and non-parametrically by Kaplan-Meier with transformations tested using a bootstrap methodology. Among 6754 patients identified, 174 patients had their first AF diagnosis cancer while 609 patients had their first diagnosis of AF cancer. Most first AF diagnosis occurred at/early after cancer diagnosis. Increasing AF prevalence at time of cancer diagnosis was seen across older age groups ranges. Diagnosis of cancer at an older age and exposure to cardiotoxic treatment (anthracyclines, HER2-neu inhibitors, tyrosine kinase inhibitors including ibrutinib and radiation) were associated with an increased risk of AF.Modelling of the hazard function of AF identified a high left-skewed peak within 3 years after cancer diagnosis ('early phase'), followed by a gradual late slight rise 3 years after cancer diagnosis ('late phase'). AF diagnosis was only associated with death in the early phase (p