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 serv...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-12-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/7/2/e001412.full |
| _version_ | 1818918419209125888 |
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| author | W H Wilson Tang Deborah H Kwon Brian Griffin Saqer Alkharabsheh Chris J Watson Feixiong Cheng Muzna Hussain Rabel Misbah Eoin Donnellan Yuan Hou Michael Crookshanks Andrew J Toth Penny Houghtaling Rohit Moudgil G Thomas Budd Wael Jaber Mohamad Kanj Patrick Collier |
| author_facet | W H Wilson Tang Deborah H Kwon Brian Griffin Saqer Alkharabsheh Chris J Watson Feixiong Cheng Muzna Hussain Rabel Misbah Eoin Donnellan Yuan Hou Michael Crookshanks Andrew J Toth Penny Houghtaling Rohit Moudgil G Thomas Budd Wael Jaber Mohamad Kanj Patrick Collier |
| author_sort | W H Wilson Tang |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-20T00:49:40Z |
| format | Article |
| id | doaj.art-3949e658feab4d7786c5605d67026ae1 |
| institution | Directory Open Access Journal |
| issn | 2053-3624 |
| language | English |
| last_indexed | 2024-12-20T00:49:40Z |
| publishDate | 2020-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj.art-3949e658feab4d7786c5605d67026ae12022-12-21T19:59:17ZengBMJ Publishing GroupOpen Heart2053-36242020-12-017210.1136/openhrt-2020-001412Impact of timing of atrial fibrillation, CHA2DS2-VASc score and cancer therapeutics on mortality in oncology patientsW H Wilson Tang0Deborah H Kwon1Brian Griffin2Saqer Alkharabsheh3Chris J Watson4Feixiong Cheng5Muzna Hussain6Rabel Misbah7Eoin Donnellan8Yuan Hou9Michael Crookshanks10Andrew J Toth11Penny Houghtaling12Rohit Moudgil13G Thomas Budd14Wael Jaber15Mohamad Kanj16Patrick Collier17Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USAHeart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USAHeart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USADepartment of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USACentre for Experimental Medicine, Queen's University Belfast, Belfast, County Antrim, UKDepartment of Genomic Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USADepartment of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USADepartment of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USADepartment of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USADepartment of Genomic Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USADepartment of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USADepartment of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, United StatesDepartment of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, United StatesDepartment of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USADepartment of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USADepartment of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USADepartment of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USADepartment of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USAObjectives 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.https://openheart.bmj.com/content/7/2/e001412.full |
| spellingShingle | W H Wilson Tang Deborah H Kwon Brian Griffin Saqer Alkharabsheh Chris J Watson Feixiong Cheng Muzna Hussain Rabel Misbah Eoin Donnellan Yuan Hou Michael Crookshanks Andrew J Toth Penny Houghtaling Rohit Moudgil G Thomas Budd Wael Jaber Mohamad Kanj Patrick Collier Impact of timing of atrial fibrillation, CHA2DS2-VASc score and cancer therapeutics on mortality in oncology patients Open Heart |
| title | Impact of timing of atrial fibrillation, CHA2DS2-VASc score and cancer therapeutics on mortality in oncology patients |
| title_full | Impact of timing of atrial fibrillation, CHA2DS2-VASc score and cancer therapeutics on mortality in oncology patients |
| title_fullStr | Impact of timing of atrial fibrillation, CHA2DS2-VASc score and cancer therapeutics on mortality in oncology patients |
| title_full_unstemmed | Impact of timing of atrial fibrillation, CHA2DS2-VASc score and cancer therapeutics on mortality in oncology patients |
| title_short | Impact of timing of atrial fibrillation, CHA2DS2-VASc score and cancer therapeutics on mortality in oncology patients |
| title_sort | impact of timing of atrial fibrillation cha2ds2 vasc score and cancer therapeutics on mortality in oncology patients |
| url | https://openheart.bmj.com/content/7/2/e001412.full |
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