Coexisting atrial fibrillation and cancer: time trends and associations with mortality in a nationwide Dutch study.

in European heart journal by Qingui Chen, Nienke van Rein, Tom van der Hulle, Julius C Heemelaar, Serge A Trines, Henri H Versteeg, Frederikus A Klok, Suzanne C Cannegieter

TLDR

  • The study looked at how having both atrial fibrillation (AF) and cancer affects your health. They found that people with both AF and cancer were more likely to die than those without either condition. The study also found that the risk of having AF or cancer increased over time. The study suggests that doctors should pay attention to people who have both AF and cancer and try to find ways to improve their health.

Abstract

Coexisting atrial fibrillation (AF) and cancer challenge the management of both. The aim of the study is to comprehensively provide the epidemiology of coexisting AF and cancer. Using Dutch nationwide statistics, individuals with incident AF (n = 320 139) or cancer (n = 472 745) were identified during the period 2015-19. Dutch inhabitants without a history of AF (n = 320 135) or cancer (n = 472 741) were matched as control cohorts by demographic characteristics. Prevalence of cancer/AF at baseline, 1-year risk of cancer/AF diagnosis, and their time trends were determined. The association of cancer/AF diagnosis with all-cause mortality among those with AF/cancer was estimated by using time-dependent Cox regression. The rate of prevalence of cancer in the AF cohort was 12.6% (increasing from 11.9% to 13.2%) compared with 5.6% in the controls; 1-year cancer risk was 2.5% (stable over years) compared with 1.8% in the controls [adjusted hazard ratio (aHR) 1.52, 95% confidence interval (CI) 1.46-1.58], which was similar by cancer type. The rate of prevalence of AF in the cancer cohort was 7.5% (increasing from 6.9% to 8.2%) compared with 4.3% in the controls; 1-year AF risk was 2.8% (stable over years) compared with 1.2% in the controls (aHR 2.78, 95% CI 2.69-2.87), but cancers of the oesophagus, lung, stomach, myeloma, and lymphoma were associated with higher hazards of AF than other cancer types. Both cancer diagnosed after incident AF (aHR 7.77, 95% CI 7.45-8.11) and AF diagnosed after incident cancer (aHR 2.55, 95% CI 2.47-2.63) were associated with all-cause mortality, but the strength of the association varied by cancer type. Atrial fibrillation and cancer were associated bidirectionally and were increasingly coexisting, but AF risk varied by cancer type. Coexisting AF and cancer were negatively associated with survival.

Overview

  • The study aims to provide the epidemiology of coexisting atrial fibrillation (AF) and cancer using Dutch nationwide statistics. The study identifies individuals with incident AF or cancer during the period 2015-19 and matches them as control cohorts by demographic characteristics. The study determines the prevalence of cancer/AF at baseline, 1-year risk of cancer/AF diagnosis, and their time trends. The association of cancer/AF diagnosis with all-cause mortality among those with AF/cancer is estimated using time-dependent Cox regression. The study finds that the rate of prevalence of cancer in the AF cohort was 12.6% compared with 5.6% in the controls, and the rate of prevalence of AF in the cancer cohort was 7.5% compared with 4.3% in the controls. The study also finds that both cancer diagnosed after incident AF and AF diagnosed after incident cancer were associated with all-cause mortality, but the strength of the association varied by cancer type. The study concludes that coexisting AF and cancer are negatively associated with survival.

Comparative Analysis & Findings

  • The study finds that the rate of prevalence of cancer in the AF cohort was 12.6% compared with 5.6% in the controls, and the rate of prevalence of AF in the cancer cohort was 7.5% compared with 4.3% in the controls. The study also finds that both cancer diagnosed after incident AF and AF diagnosed after incident cancer were associated with all-cause mortality, but the strength of the association varied by cancer type. The study concludes that coexisting AF and cancer are negatively associated with survival.

Implications and Future Directions

  • The study's findings suggest that coexisting AF and cancer are associated with increased mortality and that the association varies by cancer type. The study highlights the importance of identifying and managing coexisting AF and cancer in clinical practice. Future research could explore the mechanisms underlying the association between AF and cancer and investigate potential interventions to improve outcomes for patients with coexisting AF and cancer.
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