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. 2022 Jul;52(7):e13773.
doi: 10.1111/eci.13773. Epub 2022 Mar 28.

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  1 , Marco Vitolo  1   2   3 , Marco Proietti  2   4   5 , Igor Diemberger  6 , Laurent Fauchier  7 , Francisco Marin  8 , Michael Nabauer  9 , Tatjana S Potpara  10   11 , Gheorghe-Andrei Dan  12 , Zbigniew Kalarus  13   14 , Luigi Tavazzi  15 , Aldo Pietro Maggioni  16 , Deirdre A Lane  2   17 , Gregory Y H Lip  2   17 , Giuseppe Boriani  1 ; ESC-EHRA EORP-AF Long-Term General Registry Investigators
Collaborators, Affiliations

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 et al. Eur J Clin Invest. 2022 Jul.

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.

Keywords: NOACs; all-cause death; atrial fibrillation; cancer; malignancy; registry.

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References

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