Clinical profile and cardiovascular events in patients with atrial fibrillation and hematologic malignancies with recent initiation of targeted therapy: Real-life data from CANAC-FA registry

Abstract

Background: "Real-life" data on cardiovascular management and clinical outcomes in patients with atrial fibrillation (AF) and hematologic malignancies are limited.

Aim: To describe the clinical profile and incidence of cardiovascular events in this population.

Methods: Data were obtained from the CANAC-FA Registry, an observational, multicenter and retrospective study. A review of the medical records of patients who had consulted for chronic lymphocytic leukemia (CLL) or multiple myeloma (MM) between 2017 and 2019 was conducted in five hospitals in Spain. Patients with atrial fibrillation (AF) were identified, and the initial visit during which specific treatment for the neoplasm was administered was considered the baseline visit. The follow-up period concluded in 2021. Events of interest included major bleeding, cardiovascular events (hospital admission for cardiovascular causes or cardiovascular death), and death from any cause.

Results: A total of 7,793 patients were reviewed, of whom 1,189 (15%) had AF and 81 (1%) had AF and had initiated a specific hematological treatment within the previous year. Of these patients, 48 (59%) had MM and 33 (41%) had CLL. The mean values for the Charlson, CHA2DS2-VASc and HAS-BLED indices were 5.3 ± 1.7, 3.4 ± 1.5 and 2.4 ± 1.1, respectively. Anticoagulants were prescribed to 85% of patients, with a majority (42%) receiving direct anticoagulants. After a maximum follow-up period of 59 months, the incidences of events at 1, 2 and 3 years of follow-up were: 1.2±1.2%, 1.2±1.2 and 3.5±2.5% for major bleeding; 11.6±3.7%, 11.6±3.7 and 17.2±5.3% for cardiovascular events; and 27.6±5.0%, 41.5±6.3 and 51.3±6.9% for all-cause mortality.

Conclusions: The incidence of cardiovascular events was high in this population, suggesting the need to implement more effective preventive strategies.

Keywords: Anticoagulation; Atrial fibrillation; Cardiovascular events; Chronic lymphocytic leukaemia; Multiple myeloma.