Patients with cancer are at greater risk for atrial fibrillation (AF) than the general population, and the effect varies with cancer type, according to a study recently published in JACC: CardioOncology.
This study included 816,811 patients with cancer and 1,633,663 age- and sex-matched controls without cancer from Korea’s National Health Insurance Service database (mean age 57.5±12.5 years; 46.9% men; median follow-up duration for cancer group 4.5 [interquartile range 2.7-6.6]; noncancer group 5.5 [interquartile range 3.6-7.2] years). All patients were followed from 2009 until death, new onset AF, or the end of the study period (December 31, 2017). AF risk was compared between those with and without cancer using Kaplan-Meier estimates and a log-rank test. The type of cancer was assessed separately.
In the follow-up period, 3.1% (n=25,356; 6.6 per 1000 person-years) of individuals in the cancer group developed AF compared with 1.9% (n=31,801; 3.6 per 1,000 person-years) of those in the noncancer group. Cancer was associated with a higher likelihood of developing AF (subdistribution hazard ratio [HR] 1.64; 95% CI, 1.61-1.66). This risk was sustained after adjustments for other variables. Multiple myeloma was associated with the highest AF risk compared with controls (HR 3.34; 95% CI, 2.98-3.75), while stomach cancer was associated with the lowest risk (HR 1.27; 95% CI, 1.23-1.32). Esophageal cancer was associated with the highest risk for AF development among solid cancers (HR 2.69; 95% CI, 2.45-2.95).
Limitations to this study include unavailable information on cancer stage and treatment, potential misclassification of diagnoses, not treating death as a competing risk, including only Korean patients, and the lack of inclusion of certain outcomes.
The study researchers concluded that patients with cancer “showed a higher risk [for] AF than the general population, and the risk [for] AF development varied according to cancer type.” Furthermore, the authors indicated that an “increased risk [for] AF should be considered when treating patients with cancer.”
Yun JP, Choi EK, Han KD, et al. Risk of atrial fibrillation according to cancer type: A nationwide population-based study. JACC: CardioOncology. 2021; 3(2):221-232.