Impact of malignancy on outcomes in European patients with atrial fibrillation: A report from the ESC-EHRA EURObservational Research Programme in Atrial Fibrillation General Long-Term Registry

Vincenzo L. Malavasi, Marco Vitolo, Marco Proietti, Igor Diemberger, Laurent Fauchier, Francisco Marin, Michael Nabauer, Tatjana S. Potpara, Gheorghe-Andrei Dan, Zbigniew Kalarus, Luigi Tavazzi, Aldo Pietro Maggioni, Deirdre A. Lane, Gregory Y. H. Lip, Giuseppe Boriani*, ESC-EHRA EORP-AF Long-Term General Registry Investigators, Albert Marni Joensen (Member of study group), Anders Gammelmark (Member of study group), Lars Hvilsted Rasmussen (Member of study group), Pia Thisted Dinesen (Member of study group)Sam Riahi, Stine Krogh Venø, Birthe Ginnerup Sørensen, Anne Marie Korsgaard, Karen Petrea Andersen , Camilla Fragtrup Hellum

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: The management of patients with atrial fibrillation (AF) and malignancy is challenging given the paucity of evidence supporting their appropriate clinical management.

PURPOSE: To evaluate the outcomes of patients with active or prior malignancy in a contemporary cohort of European AF patients.

METHODS: Patients enrolled in the EURObservational Research Programme in AF General Long-Term Registry were categorized into 3 categories: No Malignancy (NoMal), Prior Malignancy (PriorMal) and Active Malignancy (ActiveMal). The primary outcomes were all-cause death and the composite outcome MACE.

RESULTS: A total of 10 383 patients were analysed. Of these, 9597 (92.4%) were NoMal patients, 577 (5.6%) PriorMal and 209 (2%) ActiveMal. Lack of any antithrombotic treatment was more prevalent in ActiveMal patients (12.4%) as compared to other groups (5.0% vs 6.3% for PriorMal and NoMal, p < .001). After a median follow-up of 730 days, there were 982 (9.5%) deaths and 950 (9.7%) MACE events. ActiveMal was independently associated with a higher risk for all-cause death (HR 2.90, 95% CI 2.23-3.76) and MACE (HR 1.54, 95% CI 1.03-2.31), as well as any haemorrhagic events and major bleeding (OR 2.42, 95% CI 1.49-3.91 and OR 4.18, 95% CI 2.49-7.01, respectively). Use of oral anticoagulants was not significantly associated with a higher risk for all-cause death or bleeding in ActiveMal patients.

CONCLUSIONS: In a large contemporary cohort of AF patients, active malignancy was independently associated with all-cause death, MACE and haemorrhagic events. Use of anticoagulants was not associated with a higher risk of all-cause death in patients with active malignancies.

Original languageEnglish
Article numbere13773
JournalEuropean Journal of Clinical Investigation
Volume52
Issue number7
Pages (from-to)e13773
ISSN0014-2972
DOIs
Publication statusE-pub ahead of print - 19 Mar 2022

Bibliographical note

© 2022 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

Keywords

  • Anticoagulants
  • Atrial Fibrillation/complications
  • Hemorrhage/chemically induced
  • Humans
  • Neoplasms/drug therapy
  • Registries
  • Risk Factors
  • Stroke/complications

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