Abstract
Background
"Real world" observational data on cardiovascular prognosis of patients with atrial fibrillation and active lung cancer are very limited.
Purpose
Our aim was to describe the ...incidence of major cardiovascular events in this population.
Methods
We used data from CANAC-FA Registry (Active Cancer and Atrial Fibrillation, in Spanish, CÁNcer ACtivo y Fibrilación Auricular), an observational, multicentre, retrospective study. The medical records of all subjects attended at the outpatient oncology clinics solely or mainly attending lung cancer patients from January 1st, 2017 to December 31st, 2019 in five tertiary university hospitals in the south of Spain were reviewed. The first visit to the oncology clinic with atrial fibrillation diagnosis (previous or at that moment), during the first year after the lung cancer diagnosis was considered the basal visit. Follow up period ended at December 31st, 2021. End points were stroke/systemic embolism, thrombotic events (stroke, systemic embolism, pulmonary embolism, deep vein thrombosis), major bleeding (International Society of Thrombosis and Haemostasis definition), and cardiovascular events (hospital admission for cardiovascular reasons or cardiovascular death). Death without the event of interest was considered a competing risk. Calculations were performed with R statistical software, cmprsk package.
Results
Among 6984 patients, 269 presented active lung cancer and atrial fibrillation (3.7%). Mean age was 71±8 years, and 91% were male. Cardiovascular risk factors were: hypertension 77%, dyslipidemia 49%, diabetes 37% and active smoking 30% (62% ex-smokers). Charlson, CHA2DS2VASc and HAS-BLED indexes were 6.7±2.9, 2.9±1.5 y 2.5±1.2, respectively. Tumor stage was I, II, III and IV in 11%, 11%, 34% and 45% of the study sample, respectively. Anticoagulants were prescribed to 84% of the patients: direct anticoagulants (44%), low molecular weight heparins (30%) and vitamin K antagonists (26%). After up to 46 months of maximum follow-up, 7 patients presented a stroke/systemic embolism, 18 had a thrombotic event, 16 presented a major bleeding, 33 had a cardiovascular event and 186 died. Cumulative incidences of major events at one, two and three years of follow-up were 2.4±1.0%, 3.3±1.3% and 3.3±1.3% for stroke/systemic embolism; 4.7±1.3%, 8.0±2.1% and 8.9±2.2% for thrombotic events; 2.7±1.0%, 6.7±1.9% and 9.9±2.6% for severe bleeding, and 9.5±1.8%, 13.4±2.5% and 15.9±3.0% for cardiovascular events (figure).
Conclusions
Cumulative incidence of cardiovascular events was 15.9% at three years in this "real world" population of patients with active lung cancer and atrial fibrillation. These data could suggest an unmet need for more effective preventive strategies in this population.Major events
Abstract
Background
Lung cancer has a poor prognosis for most patients, as it is frequently diagnosed in advanced tumour stages. Real world observational data on the impact of major cardiovascular ...events (MACE) and major bleedings (MB) in the prognosis of patients with atrial fibrillation (AF) and active lung cancer are very limited.
Purpose
Our aim was to investigate the impact of MACE and MB in mortality in this population.
Methods
We used data from CANAC-FA Registry (Active Cancer and AF, in Spanish, CÁNcer ACtivo y Fibrilación Auricular), an observational, multicentre, retrospective study. The medical records of all subjects attended at the outpatient oncology clinics solely or mainly attending lung cancer patients from January 1st, 2017 to December 31st, 2019 in five tertiary university hospitals in the south of Spain were reviewed. The first visit to the oncology clinic with AF diagnosis during the first year after the lung cancer detection was considered the basal visit. Follow up period ended at December 31st, 2021. MACE (hospital admission for cardiovascular causes) and MB (International Society of Thrombosis and Haemostasis definition) were registered, and impact on survival was assessed for the whole series and according to tumour stage.
Results
Among 6984 patients, 269 presented active lung cancer and AF (3.9%). Mean age was 71±8 years, and 91% were male. Tumour stage was I, II, III and IV in 11%, 11%, 34% and 45% of the study sample, respectively. Anticoagulants were prescribed to 84% of the patients. After up to 46 months of maximum follow-up, 33 patients presented 40 MACE (13 heart failure admissions, 9 pulmonary embolisms, 5 strokes, 5 severe symptomatic arrhythmias, 4 deep vein thrombosis, 2 transient ischemic attacks, 2 systemic embolisms and 1 acute coronary syndrome), 16 patients had a MB and 186 died. However, two years’ mortality was similar in those patients with MACE or MB in follow-up versus those without them, in the whole of series (79% versus 73%, p=0.79, figure A), and in those with advanced cancer stages (III-IV, 89% versus 85%, p=0.39, figure B). In spite of that, in those patients with early tumour stages (I-II), two years’ mortality was significantly higher in those who suffered MACE or MB than in those free of both of them (85% versus 25%, p=0.01, figure C), and this difference remained after adjusting by other independent predictors of mortality (Hazard Ratio 11.08 2.69-45.58, p=0.001).
Conclusions
In patients with AF and active lung cancer, patients with MACE and MB in follow up had similar mortality than those without them in the subgroup with advanced cancer stages. However, mortality was significantly higher in patients with these complications versus those without them in the subgroup with early cancer stages. This information could be useful for individualizing therapeutic efforts in this population.Impact of events in survival
TCT-199 FFR Saline: A Useful Adenosine-Free Index Cañadas, Dolores; Torralba, Elena; Alarcón de la Lastra Cubiles, Inara ...
Journal of the American College of Cardiology,
11/2021, Letnik:
78, Številka:
19
Journal Article
Our aim was to investigate the prevalence of atrial fibrillation (AF) and recently diagnosed lung cancer in the outpatient oncology clinic and to describe the clinical profile, management and ...outcomes of this population.
Among 6984 patients visited at the outpatient oncology clinics attending lung cancer patients in five university hospitals from 2017 to 2019, all consecutive subjects with recently diagnosed (<1 year) disease and AF were retrospectively selected and events in follow up were registered.
A total of 269 patients (3.9 % of all attended, 71 ± 8 years, 91 % male) were included. Charlson, CHA2DS2-VASc and HAS-BLED indexes were 6.7 ± 2.9, 2.9 ± 1.5 y 2.5 ± 1.2, respectively. Tumour stage was I, II, III and IV in 11 %, 11 %, 33 % and 45 % of them, respectively. Anticoagulants were prescribed to 226 patients (84 %): direct anticoagulants (n = 99;44 %), low molecular weight heparins (n = 69;30 %) and vitamin K antagonists (n = 58;26 %). After 46 months of maximum follow-up, 186 patients died (69 %). Cumulative incidences of events at 3 years were 3.3 ± 1.3 % for stroke/systemic embolism (n = 7); 8.9 ± 2.2 % for thrombotic events (n = 18); 9.9 ± 2.6 % for major bleeding (n = 16), and 15.9 ± 3,0 % for cardiovascular events (n = 33). In patients with early stages of cancer (I-II), 2-year mortality was significantly higher in those with cardiovascular events or major bleeding (85 % vs 25 %, p = 0.01).
Nearly 4 % or all outpatients in the oncology clinic attending lung cancer present recently diagnosed disease and AF. Major bleeding and cardiovascular event rates are high in this population, with an impact on mortality in early stages of cancer.
PDF
