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Management and outcomes of patients with atrial fibrillation and a history of cancer: the ORBIT-AF registry.

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Date
2017-07-01
Authors
Melloni, Chiara
Shrader, Peter
Carver, Joseph
Piccini, Jonathan P
Thomas, Laine
Fonarow, Gregg C
Ansell, Jack
Gersh, Bernard
Go, Alan S
Hylek, Elaine
Herling, Irving M
Mahaffey, Kenneth W
Yu, Anthony F
Peterson, Eric D
Kowey, Peter R
ORBIT-AF Steering Committee
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Abstract
Aims: The presence of cancer can complicate treatment choices for patients with atrial fibrillation (AF) increasing both the risk of thrombotic and bleeding events. Methods and results: Using data from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we aimed to characterize AF patients with cancer, to describe their management and to assess the association between cancer and cardiovascular (CV) outcomes. Among 9749 patients, 23.8% had history of cancer (57% solid malignancy, 1.3% leukaemia, 3.3% lymphoma, 40% other type, and 2.2% metastatic cancer). Patients with history of cancer were older, more likely to have CV disease, CV risk factors, and prior gastrointestinal bleeding. No difference in antiarrhythmic and antithrombotic therapy was observed between those with and without cancer. Patients with history of cancer had a significantly higher risk of death (7.8 vs. 4.9 deaths per 100 patient-years follow-up, P = 0.0003) mainly driven by non-CV death (4.2 vs. 2.4 per 100 patient-years follow-up; P = 0.0004) and higher risk of major bleeding (5.1 vs. 3.5 per 100 patient-years follow-up; P = 0.02) compared with non-cancer patients; no differences were observed in risks of strokes/non-central nervous system embolism (1.96 vs. 1.48, P = 0.74) and CV death (2.89 vs. 2.07, P = 0.35) between the two groups. Conclusion: A history of cancer is common among AF patients with up to one in four patients having both. Antithrombotic therapy, rates of cerebrovascular accident, other thrombotic events and cardiac death were similar in AF patients with or without a history of cancer. Patients with cancer, however, were at higher risk of major bleeding and non-CV death.
Type
Journal article
Subject
Anticoagulant therapy
Atrial fibrillation
Cancer
Permalink
https://hdl.handle.net/10161/15414
Published Version (Please cite this version)
10.1093/ehjqcco/qcx004
Publication Info
Melloni, Chiara; Shrader, Peter; Carver, Joseph; Piccini, Jonathan P; Thomas, Laine; Fonarow, Gregg C; ... ORBIT-AF Steering Committee (2017). Management and outcomes of patients with atrial fibrillation and a history of cancer: the ORBIT-AF registry. Eur Heart J Qual Care Clin Outcomes, 3(3). pp. 192-197. 10.1093/ehjqcco/qcx004. Retrieved from https://hdl.handle.net/10161/15414.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Melloni

Chiara Melloni

Adjunct Associate Professor in the Department of Medicine
Peterson

Eric David Peterson

Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical Research Institute (DCRI), Durham, NC, USA. Dr Peterson is the Principal Investigator of the National Institute of Health, Lung and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial  He is also the Principal I
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
Piccini

Jonathan Paul Piccini Sr.

Associate Professor of Medicine
Jonathan P. Piccini, MD, MHS, FACC, FAHA, FHRS is a clinical cardiac electrophysiologist and Associate Professor of Medicine with Tenure at Duke University Medical Center and the Duke Clinical Research Institute. He is the Director of the Cardiac Electrophysiology section at the Duke Heart Center. His focus is on the care of patients with atrial fibrillation and complex arrhythmias, with particular emphasis on catheter ablation, left atrial appendage occlusion, and lead extraction. His resear
Thomas

Laine Elliott Thomas

Associate Professor of Biostatistics & Bioinformatics
Causal Inference, Heterogeneity of Treatment Effects, Observational Data, Time-varying Treatments, Real World Evidence
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