Concomitant Cancer, Atrial Fibrillation Linked to Increased In-Hospital Mortality

Among patients hospitalized with cancer, atrial fibrillation (AF) was associated with longer hospital stays, poorer outcomes, and increased mortality, according to a large retrospective cohort analysis. The findings were presented during the American College of Cardiology Annual Meeting, held virtually from May 15 to 17, 2021.

Researchers from Memorial Healthcare System in Hollywood, Florida, analyzed data from the National Inpatient Sample collected in 2016. Patients hospitalized with cancer (N=1,022,625) were assessed for AF and clinical outcomes. Of these, 10.46% of patients (n=107,000) hospitalized for cancer were also diagnosed with AF.

Stratified by AF status, patients with cancer and comorbid AF had longer hospital stays (8.58 vs 6.29 days; P <.001) and increased in-hospital mortality (8.66% vs 4.32%; P <.001).

Adverse outcomes such as ventricular tachycardia/fibrillation (odds ratio [OR], 4.95), cardiogenic shock (OR, 4.35), septic shock (OR, 3.38), intubation (OR, 2.96), respiratory failure (OR, 2.88), in-hospital cardiac arrest (OR, 2.61), stroke or transient ischemic attack (OR, 2.41), sepsis (OR, 2.34), acute kidney injury (OR, 2.23), transfer to palliative care (OR, 1.59), red blood cell transfusion (OR, 1.42), pulmonary embolism (OR, 1.41), deep vein thrombosis (OR, 1.40), and platelet transfusion (OR, 1.31) were increased among patients with cancer and AF comorbidities (all P <.001).

Stratified by cancer type, patients with AF were at increased risk for in-hospital mortality if they had comorbid rectal cancer (OR, 2.04; 95% CI, 1.23-3.38; P =.006), breast cancer (OR, 2.01; 95% CI, 1.13-3.57; P =.018), leukemia (OR, 1.88; 95% CI, 1.56-2.25; P <.001), liver cancer (OR, 1.78; 95% CI, 1.23-2.58; P =.002), lymphoma (OR, 1.43; 95% CI, 1.07-1.93; P =.017), lung cancer (OR, 1.41; 95% CI, 1.25-1.59), or colon cancer (OR, 1.37; 95% CI, 1.05-1.79; P =.021).

In contrast, patients with AF and comorbid melanoma, bladder, brain, esophageal, kidney, ovary, pancreatic, prostate, or stomach cancers were not at increased risk for in-hospital mortality.

This study may have included errors or missing data, and carries the potential bias inherent in any retrospective review of medical records.

The study data indicate that patients with AF and certain cancers may be at greater risk for poorer clinical outcomes, longer hospital stay, and in-hospital mortality.

Reference

Clark L, Wu F, Krishnan AM, Li P. Concomitant atrial fibrillation is associated with higher mortality and morbidity in patients hospitalized for cancer. Presented at: American College of Cardiology (ACC) 2021 Annual Meeting; May 15-17, 2021. Abstract.