Characteristics and Management of Patients With Cancer and Atrial Fibrillation: The BLITZ-AF Cancer Registry

Abstract

Background: Atrial fibrillation (AF) is a frequent cardiovascular (CV) comorbidity in cancer.

Objectives: The purpose of this study was to examine clinical characteristics and contemporary management of patients with AF and cancer with a specific focus on antithrombotic treatments.

Methods: This was a prospective, multicenter, observational study of patients with a recent cancer diagnosis and electrocardiographically confirmed AF (the BLITZ-AF Cancer Registry). CHA₂DS₂VASc scores were calculated for study participants.

Results: Overall, 1,514 individuals were enrolled from June 2019 to September 2021 (mean age 74 ± 9 years, 47.5% of participants >75 years of age; 63.5% males). CV diseases were common: 20.9% had heart failure, 18.1% had coronary artery disease, 38.5% had valvular heart disease, and 9.8% had peripheral artery disease. Previous thromboembolic and hemorrhagic events occurred in 13.9% and 10.4% of subjects, respectively. The most common cancer types were lung (14.9%), colorectal (14.1%), prostate (8.8%), and non-Hodgkin lymphoma (8.1%). In total, 41.5% of the patients had a CHA₂DS₂VASc score ≥4. Before admission or prior to cardiologist consultation, 16.6% of subjects were not taking any antithrombotic therapy and 22.7% were receiving antiplatelet agents and/or low-molecular-weight heparin. At discharge or after cardiologic assessment, these percentages dropped to 7.7% and 16.6%, respectively. This trend was paralleled by an increase in the use of direct-acting oral anticoagulant, while the proportion of vitamin K antagonist declined.

Conclusions: This study demonstrates that there is underuse of appropriate antithrombotic therapy for AF in cancer patients highlighting the need to integrate early CV assessment in the management of these patients. (Non-interventional Study on Patients With Atrial Fibrillation and Cancer [BLITZ-AF Cancer]; NCT03909386).

Keywords: antithrombotic; atrial fibrillation; cancer; comorbidities; oral anticoagulants.

Graphical abstract

Figure 1

Patterns of Antithrombotic Therapy in the BLITZ-AF Cancer Cohort, Before and After Admission or Evaluation at the Study Centers The importance of cardiologist’s involvement. AT = antithrombotic; DOAC = direct-acting oral anticoagulant; VKA = vitamin K antagonist.

Central Illustration

Characteristics and Antithrombotic Management of Patients With Cancer and Atrial Fibrillation ∗Inappropriately treated is defined as receiving antithrombotic therapy not recommended for thromboprophylaxis in AF (ie, antiplatelet agents and/or low-molecular-weight-heparin). AF = atrial fibrillation; DOAC = direct-acting oral anticoagulant.