Impact of timing of atrial fibrillation, CHA2DS2-VASc score and cancer therapeutics on mortality in oncology patients.
OBJECTIVES
To investigate timing and age distribution of atrial fibrillation (AF) in selected oncology patients, and the impact of AF timing, CHA2DS2-VASc score and cancer therapeutics on mortality.


METHODS
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.


RESULTS
Among 6754 patients identified, 174 patients had their first AF diagnosis before cancer while 609 patients had their first diagnosis of AF after 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<0.001), while CHA2DS2-VASc score was only associated with death in the late phase (p<0.001).


CONCLUSIONS
This study reports a nuanced/complex relationship between AF and cancer. First diagnosis of AF in patients with cancer was more common at/early after cancer diagnosis, especially in older patients and those exposed to cardiotoxic treatment. Pre-existing AF or a diagnosis of AF within 3 years after cancer diagnosis carried a negative prognosis. CHA2DS2-VASc score did not relate to mortality in those that developed AF within 3 years of cancer diagnosis.
['Hussain|Muzna|M|0000-0003-1533-6634', 'Misbah|Rabel|R|', 'Donnellan|Eoin|E|', 'Alkharabsheh|Saqer|S|', 'Hou|Yuan|Y|', 'Cheng|Feixiong|F|', 'Crookshanks|Michael|M|', 'Watson|Chris J|CJ|', 'Toth|Andrew J|AJ|', 'Houghtaling|Penny|P|', 'Moudgil|Rohit|R|', 'Budd|G Thomas|GT|', 'Tang|W H Wilson|WHW|', 'Kwon|Deborah H|DH|', 'Jaber|Wael|W|', 'Griffin|Brian|B|', 'Kanj|Mohamad|M|', 'Collier|Patrick|P|']
D000368:Aged D001281:Atrial Fibrillation D005500:Follow-Up Studies D006801:Humans D008875:Middle Aged D009369:Neoplasms D011237:Predictive Value of Tests D011379:Prognosis D057216:Propensity Score D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors
atrial fibrillation risk factors malignancy