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. 2025 Feb 25;20(2):e0319342.
doi: 10.1371/journal.pone.0319342. eCollection 2025.

Cardiology involvement and mortality in adult patients with advanced solid cancer complicated by atrial fibrillation

Takeshi Sato  1   2 , Zhehao Dai  3   4 , Jun Hashimoto  5 , Sachiko Ohde  6 , Nobuyuki Komiyama  4 , Takayuki Inomata  2 , Teruo Yamauchi
Affiliations

Cardiology involvement and mortality in adult patients with advanced solid cancer complicated by atrial fibrillation

Takeshi Sato et al. PLoS One. .

Abstract

Background: The association between comorbid atrial fibrillation (AF) and survival in adult patients with advanced solid cancer, as well as the impact of cardiology involvement in such patients, remains unclear.

Methods: This retrospective cohort study included adult patients diagnosed with advanced solid cancers. We calculated prevalence of AF in different cancer types and compared all-cause mortality between patients with and without AF. We further examined the association between cardiology involvement and mortality in the subset of participants with AF.

Results: Among the 1,349 adult patients with advanced solid cancer, 122 (9.0%) had AF. The risk of AF was the highest in lung and mediastinal cancer (15.6%). AF was associated with higher all-cause mortality, which became neutral after adjustment for age, sex, comorbidities, cancer types and cancer treatments (crude hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.11-1.75, p = 0.004; adjusted HR 1.08, 95%CI 0.84-1.39, p = 0.552). In those with AF, cardiology involvement was independently associated with lower all-cause mortality (age, sex, comorbidities, cancer types and cancer treatments-adjusted HR 0.50 [95%CI 0.28-0.88], p = 0.017), though the cumulative incidence of neither cardiovascular nor non-cardiovascular death differed significantly between patients who received cardiology care and those who did not.

Conclusions: In adult patients with advanced solid cancer, AF per se was not independently associated with increased mortality. Cardiology involvement in patients with advanced solid cancer and AF was linked to a better overall survival, but with low certainty that this finding is not attributable to unmeasured confounding.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. CONSORT flow diagram of patients inclusion and exclusion.
AF, atrial fibrillation; CONSORT, Consolidated Standards of Reporting Trials.
Fig 2
Fig 2. The risk of AF in adult patients with advanced solid cancer across different cancer types.
*Other cancers included gynecological cancer, thyroid cancer, oral cancer, head and neck cancer, sarcoma, and carcinoma of unknown primary. AF, atrial fibrillation.
Fig 3
Fig 3. Kaplan-Meier estimates of overall survival in adult patients with advanced solid cancer with and without AF.
Shaded zones indicate 95% confidence intervals. AF, atrial fibrillation.
Fig 4
Fig 4. Kaplan-Meier estimates of overall survival among adult patients with advanced solid cancer without AF, with AF and cardiology involvement, and with AF without cardiology involvement.
Shaded zones indicate 95% confidence intervals. * Log-rank p <  0.001. †Log-rank p =  0.016. ‡Log-rank p =  0.475. AF, atrial fibrillation.
Fig 5
Fig 5. Cumulative incidences of cardiovascular and non-cardiovascular deaths stratified by cardiology involvement among adult patients with advanced solid cancer and AF. Solid lines indicate cumulative incidences of cardiovascular deaths; and dashed lines indicate cumulative incidences of non-cardiovascular deaths. Shaded zones indicate 95% confidence intervals. AF, atrial fibrillation; CV, cardiovascular.
See this image and copyright information in PMC

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