Management and outcomes of patients with atrial fibrillation and a history of cancer: the ORBIT-AF registry.
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 articlePermalink
https://hdl.handle.net/10161/15414Published Version (Please cite this version)
10.1093/ehjqcco/qcx004Publication 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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Show full item recordScholars@Duke
Chiara Melloni
Adjunct Associate Professor in the Department of Medicine
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.
Jonathan Paul Piccini Sr.
Professor of Medicine
Jonathan P. Piccini, MD, MHS, FACC, FAHA, FHRS is a clinical cardiac electrophysiologist
and Professor of Medicine 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 and lead extraction.
His research interests include the development and evaluation of i
Laine Elliott Thomas
Professor of Biostatistics & Bioinformatics
As Deputy Director, Laine Thomas, PhD provides complementary leadership in strategy
and development of the group and DCRI. She has an outstanding record of scientific
and strategic collaboration, independent research, leadership and mentoring well known
to her colleagues at the DCRI.
Thomas joined the DCRI in 2009. She serves as Associate Director for Biostatistics
at DCRI and Associate Chair for Equity, Diversity and Inclusion within the Department
of
Alphabetical list of authors with Scholars@Duke profiles.

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