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Angeli F, Bergamaschi L, Armillotta M, Sansonetti A, Stefanizzi A, Canton L, Bodega F, Suma N, Amicone S, Fedele D, Bertolini D, Impellizzeri A, Tattilo FP, Cavallo D, Bartoli L, Di Iuorio O, Ryabenko K, Casuso Alvarez M, Marinelli V, Asta C, Ciarlantini M, Pastore G, Rinaldi A, Pomata DP, Caldarera I, Pizzi C. Impact of Newly Diagnosed Cancer on Bleeding Events in Patients with Atrial Fibrillation Treated with Direct Oral Anticoagulants. Am J Cardiovasc Drugs 2024:10.1007/s40256-024-00676-y. [PMID: 39240455 DOI: 10.1007/s40256-024-00676-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND In patients with atrial fibrillation (AF), the association between cancer and cardioembolic or bleeding risk during oral anticoagulant therapy still remains unclear. PURPOSE We aimed to assess the impact of cancer present at baseline (CB) or diagnosed during follow-up (CFU) on bleeding events in patients treated with direct oral anticoagulants (DOACs) for non-valvular AF (NVAF) compared with patients without CB or CFU, respectively. METHODS All consecutive patients with NVAF treated with DOACs for stroke prevention were enrolled between January 2017 and March 2019. Primary outcomes were bleeding events or cardiovascular death, non-fatal stroke and non-fatal myocardial infarction, and the composite endpoint between patients with and without CB and between patients with and without CB. RESULTS The study population comprised 1170 patients who were followed for a mean time of 21.6 ± 9.5 months. Overall, 81 patients (6.9%) were affected by CB, while 81 (6.9%) were diagnosed with CFU. Patients with CFU were associated with a higher risk of bleeding events and major bleeding compared with patients without CFU. Such an association was not observed between the CB and no CB populations. In multivariate analysis adjusted for anemia, age, creatinine, CB and CFU, CFU but not CB remained an independent predictor of overall and major bleeding (hazard ratio [HR] 2.67, 95% confidence interval [CI] 1.8-3.89, p < 0.001; HR 3.02, 95% CI 1.6-3.81, p = 0.001, respectively). CONCLUSION During follow-up, newly diagnosed primitive or metastatic cancer in patients with NVAF taking DOACs is a strong predictor of major bleeding regardless of baseline hemorrhagic risk assessment. In contrast, such an association is not observed with malignancy at baseline. Appropriate diagnosis and treatment could therefore reduce the risk of cancer-related bleeding.
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Affiliation(s)
- Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Stefanizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Lisa Canton
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesca Bodega
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Nicole Suma
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Damiano Fedele
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Davide Bertolini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Impellizzeri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Pio Tattilo
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Daniele Cavallo
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Lorenzo Bartoli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Ornella Di Iuorio
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Khrystyna Ryabenko
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marcello Casuso Alvarez
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Virginia Marinelli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Claudio Asta
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mariachiara Ciarlantini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giuseppe Pastore
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Rinaldi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Daniela Paola Pomata
- Division of Emergency Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ilaria Caldarera
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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Xu QQ, Han SJ, Wei XH, You LZ, Sun LC, Shang HC. Risk factors for arrhythmias occurred in cancer patients after chemotherapy: An evidence-based systematic review and meta-analysis. Heliyon 2024; 10:e34176. [PMID: 39104480 PMCID: PMC11298829 DOI: 10.1016/j.heliyon.2024.e34176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 06/28/2024] [Accepted: 07/04/2024] [Indexed: 08/07/2024] Open
Abstract
Objectives This study aimed to summarize the existing literature on risk factors for arrhythmias after chemotherapy in cancer patients. To provide reliable evidence for treating arrhythmias after chemotherapy in oncology patients by assessing multiple biasing factors in the literature and quantifying the risk factors. Methods The risk factors for arrhythmia following tumor chemotherapy were systematically collected from various reputable databases, including PubMed, Cochrane Library, MEDLINE, EMBASE, and multiple Chinese databases, covering the period from inception to May 2023. Two independent reviewers performed rigorous article screening, data extraction, and assessment of research quality. Data analysis was conducted using Review Manager 5.4 software, ensuring a standardized and robust approach to evaluate the gathered evidence. Results The analysis of chemotherapy-induced arrhythmias included 16 articles, encompassing 14,785 cancer patients. Among the patients, 3295 belonged to the arrhythmia group, while 11,490 were in the non-arrhythmia group. These studies identified 12 significant risk factors associated with arrhythmias following chemotherapy in cancer patients. The findings of the analysis are as follows. General patient characteristics The incidence of post-chemotherapy arrhythmias was 14.33 times higher in oncology patients aged ≥60 years compared to patients <60 years of age [OR = 14.33, 95%CI (8.51, 24.13), P<0.00001]. Patients with a smoking history exhibited a 1.67-fold higher risk of arrhythmia after chemotherapy [OR = 1.67, 95%CI (1.24, 2.25), P = 0.0007]. However, there was no significant correlation between gender and body mass index (BMI) with arrhythmia after chemotherapy in oncology patients (P = 0.52; P = 0.19). Disease-related factors Patients with a history of hypertension, diabetes, and cardiovascular disease had a 1.93-fold, 1.30-fold, and 1.76-fold increased risk of arrhythmia after chemotherapy, respectively [OR = 1.93, 95%CI (1.66, 2.24), P<0.00001; OR = 1.30, 95%CI (1.10, 2.52), P = 0.002; OR = 1.76, 95%CI (1.51, 2.05), P<0.00001]. Additionally, the incidence of arrhythmia increased 1.97 times in patients with electrolyte and acid-base balance disorders following chemotherapy [OR = 1.97, 95%CI (1.41, 2.76), P<0.00001]. Chemotherapy-related factors Seven articles examined the association between chemotherapy drugs and post-chemotherapy arrhythmias. The results indicated that oncology patients were 3.03 times more likely to develop arrhythmias with chemotherapy drugs compared to non-chemotherapy drugs [OR = 3.03, 95%CI (2.59, 3.54), P<0.00001]. Notably, anthracyclines and fluorouracil chemotherapy demonstrated a 2.98-fold and 3.35-fold increased risk of arrhythmia after chemotherapy, respectively [OR = 2.98, 95%CI (2.51, 3.03), P<0.00001; OR = 3.35, 95%CI (2.20, 5.10), P<0.00001]. The risk of arrhythmia after chemotherapy was 1.72 times higher in patients with chemotherapy cycles longer than 4 weeks than those with cycles shorter than 4 weeks [OR = 1.72, 95%CI (1.30, 2.28), P = 0.0001]. Conclusion The occurrence of arrhythmia after chemotherapy in cancer patients was significantly associated with the patient's age, history of smoking, history of hypertension, history of diabetes, history of cardiovascular disease, chemotherapy drug use, and cycle. However, further high-quality evidence is needed to support these results.
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Affiliation(s)
- Qian-Qian Xu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Song-Jie Han
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xiao-Hong Wei
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Liang-zhen You
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Li-Chao Sun
- National Cancer Center National Clinical Research Center for Cancer State Key Laboratory of Molecular Oncology of Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hong-Cai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
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Chen Q, van Rein N, van der Hulle T, Heemelaar JC, Trines SA, Versteeg HH, Klok FA, Cannegieter SC. Coexisting atrial fibrillation and cancer: time trends and associations with mortality in a nationwide Dutch study. Eur Heart J 2024; 45:2201-2213. [PMID: 38619538 PMCID: PMC11231645 DOI: 10.1093/eurheartj/ehae222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/24/2024] [Accepted: 03/26/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND AND AIMS Coexisting atrial fibrillation (AF) and cancer challenge the management of both. The aim of the study is to comprehensively provide the epidemiology of coexisting AF and cancer. METHODS Using Dutch nationwide statistics, individuals with incident AF (n = 320 139) or cancer (n = 472 745) were identified during the period 2015-19. Dutch inhabitants without a history of AF (n = 320 135) or cancer (n = 472 741) were matched as control cohorts by demographic characteristics. Prevalence of cancer/AF at baseline, 1-year risk of cancer/AF diagnosis, and their time trends were determined. The association of cancer/AF diagnosis with all-cause mortality among those with AF/cancer was estimated by using time-dependent Cox regression. RESULTS The rate of prevalence of cancer in the AF cohort was 12.6% (increasing from 11.9% to 13.2%) compared with 5.6% in the controls; 1-year cancer risk was 2.5% (stable over years) compared with 1.8% in the controls [adjusted hazard ratio (aHR) 1.52, 95% confidence interval (CI) 1.46-1.58], which was similar by cancer type. The rate of prevalence of AF in the cancer cohort was 7.5% (increasing from 6.9% to 8.2%) compared with 4.3% in the controls; 1-year AF risk was 2.8% (stable over years) compared with 1.2% in the controls (aHR 2.78, 95% CI 2.69-2.87), but cancers of the oesophagus, lung, stomach, myeloma, and lymphoma were associated with higher hazards of AF than other cancer types. Both cancer diagnosed after incident AF (aHR 7.77, 95% CI 7.45-8.11) and AF diagnosed after incident cancer (aHR 2.55, 95% CI 2.47-2.63) were associated with all-cause mortality, but the strength of the association varied by cancer type. CONCLUSIONS Atrial fibrillation and cancer were associated bidirectionally and were increasingly coexisting, but AF risk varied by cancer type. Coexisting AF and cancer were negatively associated with survival.
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Affiliation(s)
- Qingui Chen
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Nienke van Rein
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Tom van der Hulle
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Julius C Heemelaar
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Cardiovascular Imaging Research Center, Division of Cardiology, and Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
| | - Serge A Trines
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Henri H Versteeg
- Department of Medicine, Section of Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Frederikus A Klok
- Department of Medicine, Section of Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Medicine, Section of Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Imran S, Rao MS, Shah MH, Gaur A, Guernaoui AE, Roy S, Roy S, Bharadwaj HR, Awuah WA. Evolving perspectives in reverse cardio-oncology: A review of current status, pathophysiological insights, and future directives. Curr Probl Cardiol 2024; 49:102389. [PMID: 38184129 DOI: 10.1016/j.cpcardiol.2024.102389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/08/2024]
Abstract
Cardiovascular disease (CVD) and cancer are leading causes of mortality worldwide, traditionally linked through adverse effects of cancer therapies on cardiovascular health. However, reverse cardio-oncology, a burgeoning field, shifts this perspective to examine how cardiovascular diseases influence the onset and progression of cancer. This novel approach has revealed a higher likelihood of cancer development in patients with pre-existing cardiovascular conditions, attributed to shared risk factors such as obesity, a sedentary lifestyle, and smoking. Underlying mechanisms like chronic inflammation and clonal hematopoiesis further illuminate the connections between cardiovascular ailments and cancer. This comprehensive narrative review, spanning a broad spectrum of studies, outlines the syndromic classification of cardio-oncology, the intersection of cardiovascular risk factors and oncogenesis, and the bidirectional dynamics between CVD and cancer. Additionally, the review also discusses the pathophysiological mechanisms underpinning this interconnection, examining the roles of cardiokines, genetic factors, and the effects of cardiovascular therapies and biomarkers in cancer diagnostics. Lastly, it aims to underline future directives, emphasising the need for integrated healthcare strategies, interdisciplinary research, and comprehensive treatment protocols.
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Affiliation(s)
- Shahzeb Imran
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Medha Sridhar Rao
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Muhammad Hamza Shah
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom; Centre for Anatomy, Deanery of Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Aditya Gaur
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Abderrahmane El Guernaoui
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Subham Roy
- Hull York Medical School, University of York, York, United Kingdom
| | - Sakshi Roy
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
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Boutas I, Kontogeorgi A, Kalantaridou SN, Dimitrakakis C, Patsios P, Kalantzi M, Xanthos T. Reverse Onco-Cardiology: What Is the Evidence for Breast Cancer? A Systematic Review of the Literature. Int J Mol Sci 2023; 24:16500. [PMID: 38003690 PMCID: PMC10671526 DOI: 10.3390/ijms242216500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
Breast cancer and cardiovascular diseases (CVD) represent significant global health challenges, with CVD being the leading cause of mortality and breast cancer, showing a complex pattern of incidence and mortality. We explore the intricate interplay between these two seemingly distinct medical conditions, shedding light on their shared risk factors and potential pathophysiological connections. A specific connection between hypertension (HTN), atrial fibrillation (AF), myocardial infarction (MI), and breast cancer was evaluated. HTN is explored in detail, emphasizing the role of aging, menopause, insulin resistance, and obesity as common factors linking HTN and breast cancer. Moreover, an attempt is made to identify the potential impact of antihypertensive medications and highlight the increased risk of breast cancer among those women, with a focus on potential mechanisms. A summary of key findings underscores the need for a multisystem approach to understanding the relationship between CVD and breast cancer is also explored with a highlight for all the gaps in current research, such as the lack of clinical observational data on MI and breast cancer in humans and the need for studies specifically designed for breast cancer. This paper concludes that there should be a focus on potential clinical applications of further investigation in this field, including personalized prevention and screening strategies for women at risk. Overall, the authors attempt to provide a comprehensive overview of the intricate connections between breast cancer and cardiovascular diseases, emphasizing the importance of further research in this evolving field of cardio-oncology.
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Affiliation(s)
- Ioannis Boutas
- Breast Unit, Rea Maternity Hospital, 383 Andrea Siggrou Ave., Paleo Faliro, 175 64 Athens, Greece
| | - Adamantia Kontogeorgi
- Medical School, University of Crete, 13 Andrea Kalokairinoy Ave., 715 00 Giofirakia, Greece
| | - Sophia N. Kalantaridou
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Str., 124 62 Chaidari, Greece;
| | - Constantine Dimitrakakis
- First Department of Obstetrics and Gynecology, Alexandra University Hospital, Medical School, National and Kapodistrian University of Athens, 4-2 Lourou Str., 115 28 Athens, Greece;
| | - Panagiotis Patsios
- Cardiology Department, Elpis General Hospital, 7 Dimitsana Str., 115 22 Athens, Greece;
| | - Maria Kalantzi
- Post Graduate Study Program “Cardiopulmonary Resuscitation”, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 115 27 Athens, Greece;
| | - Theodoros Xanthos
- School of Health Sciences, University of West Attica, 28 Aghiou Spyridonos Str., 122 43 Aigaleo, Greece;
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Miqdad MA, Alatta L, Mohamed DS, Syed N, Ali M, Elomeiri L, Alamin A, Zubair H, Abdalla Y, Abdelrahman N. The Mysterious Association Between Atrial Fibrillation and Cancer: A Literature Review. Cureus 2023; 15:e47278. [PMID: 38021682 PMCID: PMC10656037 DOI: 10.7759/cureus.47278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Atrial fibrillation (AF) is a prevalent cardiac dysrhythmia, particularly affecting older adults, with its prevalence rising due to the aging population. AF is linked to several adverse outcomes, including embolic stroke, heart failure, and cancer. The association between AF and cancer is intricate and not yet fully understood. Studies suggest that the rise in cancer survivorship, along with cancer treatments, may contribute to an increased incidence of AF among cancer patients. This literature review was conducted using various databases to explore the relationship between AF and cancer. Studies from 2002 to 2022 were included, focusing on the adult population. Independent authors evaluated and validated the studies, ensuring rigorous methodology. The connection between AF and cancer appears multifaceted. There is evidence of increased cancer incidence within the first few months following an AF diagnosis, with potential shared risk factors like age, obesity, and smoking. Medications used to treat AF, notably amiodarone, were associated with increased cancer risk. Colon cancer risk might be linked to anticoagulation-induced gastrointestinal bleeding. It remains uncertain whether AF diagnosis leads to early cancer detection or if cancer itself contributes to AF development. The complex interplay between AF and cancer involves shared risk factors, potential medication-related influences, and unclear causal directions. The intricacies of this relationship warrant further research to clarify the underlying mechanisms and potential interactions. A comprehensive meta-analysis could provide more insights into this intriguing association and guide future clinical interventions.
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Affiliation(s)
- Mohammed A Miqdad
- Research, Michigan State University, East Lansing, USA
- Nephrology, NewYork-Presbyterian, New York, USA
| | - Lina Alatta
- Research, Michigan State University, East Lansing, USA
- Nephrology, NewYork-Presbyterian Queens, New York, USA
| | | | - Naureen Syed
- Research, Michigan State University, East Lansing, USA
| | - Mazin Ali
- Research, Michigan State University, East Lansing, USA
- Internal Medicine, University of Maryland Capital Region, Lake Arbor, USA
| | | | - Amal Alamin
- Research, Michigan State University, East Lansing, USA
| | - Hina Zubair
- Research, Michigan State University, East Lansing, USA
| | | | - Nadir Abdelrahman
- Family Medicine/Geriatrics, Michigan State University College of Human Medicine, East Lansing, USA
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7
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Sharma NR, Basnet A, Lamichhane S, Kansakar S, Seitillari A, Rivera Boadla ME, Gautam S, Kc P, Tiwari K, Singh A, Basnet S, Lamichhane B, Pokhrel M. Outcome of Atrial Fibrillation Ablation in Cancer Patients: A Review. Cureus 2023; 15:e47818. [PMID: 38022229 PMCID: PMC10676746 DOI: 10.7759/cureus.47818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Atrial fibrillation (AF), a cardiac arrhythmia, exhibits a heightened prevalence among individuals diagnosed with cancer, notably prominent in cases of lung and gastrointestinal malignancies. Robust evidence from extensive studies underscores this association, emphasizing its clinical significance. However, the precise mechanistic underpinnings and specific risk factors linking cancer and AF remain a subject of incomplete understanding. Notably, the prevalence of AF in cancer patients substantially exceeds that in non-cancer counterparts, prompting further exploration of the underlying pathophysiological processes. This review aims to address the existing knowledge void regarding AF management in cancer patients, with a specific focus on the potential role of ablation procedures. While catheter and surgical ablation techniques have been thoroughly investigated and validated as effective treatments within non-cancer populations, their applicability and outcomes in cancer patients have remained inadequately explored. The principal objective of this exhaustive review is to bridge this research gap by conducting a meticulous examination of the feasibility, safety, and effectiveness of ablation interventions for AF in the context of cancer patients. By amalgamating existing evidence and pinpointing critical areas necessitating additional investigation, this review endeavors to provide invaluable insights into AF management in cancer patients, with the ultimate goal of enhancing their clinical care and optimizing outcomes.
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Affiliation(s)
- Nava R Sharma
- Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | - Arjun Basnet
- Cardiology, Tower Health Medical Group, West Reading, USA
| | | | - Sajog Kansakar
- Internal Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | | | | | | | - Prabal Kc
- Internal Medicine, Rasuwa District Hospital, Kathmandu, NPL
| | - Kripa Tiwari
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | | | - Sijan Basnet
- Internal Medicine, The Reading Hospital and Medical Center, Wyomissing, USA
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8
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Hassan MA, Batta Y, Afzal MA, Grewal N. Chemotherapy-Induced Atrial Fibrillation With Rapid Ventricular Response in a Patient With Pleomorphic Rhabdomyosarcoma: A Case Report and Approach to Management. Cureus 2023; 15:e39375. [PMID: 37362481 PMCID: PMC10285715 DOI: 10.7759/cureus.39375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Its prevalence in cancer patients undergoing treatment with radiation or chemotherapeutic agents has been on the rise. The most common offending agents are alkylating agents and anthracyclines causing various types of arrhythmias, including AF. We report a case of a 62-year-old male who was diagnosed with stage IV pleomorphic rhabdomyosarcoma and was started on chemotherapy with a mesna-ifosfamide and doxorubicin (MAI) regimen. He developed AF with a rapid ventricular rate soon after his second cycle of treatment, which got better with the initiation of beta-blocker therapy. Since low blood counts, including low platelet levels, are expected in patients with chemotherapy, the continual use of anticoagulation therapy varies on a case-to-case basis.
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Affiliation(s)
- Mubariz A Hassan
- Internal Medicine, Howard University Hospital, Washington, D.C., USA
| | - Yashvardhan Batta
- Internal Medicine, Howard University Hospital, Washington, D.C., USA
| | | | - Niyati Grewal
- Internal Medicine, Howard University Hospital, Washington, D.C., USA
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9
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Yao X, Hu Q, Liu X, Ling Q, Leng Y, Zhao H, Yu P, Ma J, Zhao Y, Liu M, Yang R. Atrial fibrillation and breast cancer—Vicious twins? A systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1113231. [PMID: 36970342 PMCID: PMC10036368 DOI: 10.3389/fcvm.2023.1113231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundEpidemiological studies suggest a bidirectional association between atrial fibrillation and breast cancer. This study aimed to conduct a meta-analysis to elucidate the prevalence of atrial fibrillation among breast cancer patients, and the bidirectional association between atrial fibrillation and breast cancer.MethodsPubMed, the Cochrane Library, and Embase were searched to identify studies reporting the prevalence, incidence, and bidirectional association between atrial fibrillation and breast cancer. The study was registered with PROSPERO (CRD42022313251). Levels of evidence and recommendations were assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).ResultsTwenty-three studies (17 retrospective cohort studies, 5 case-control studies and 1 cross-sectional study) involving 8,537,551 participants were included. Among patients with breast cancer, the prevalence of atrial fibrillation was 3% (11 studies; 95% CI: 0.6 to 7.1%) and the incidence was 2.7% (6 studies; 95% CI: 1.1 to 4.9%). Breast cancer was associated with increased risk of atrial fibrillation (5 studies; hazard ratio [HR]: 1.43, 95% CI: 1.12 to 1.82, I2 = 98%). Atrial fibrillation was also significantly associated elevated risk of breast cancer (5 studies HR: 1.18, 95% CI: 1.14 to 1.22, I2 = 0%). Grade assessment shown low certainty of the evidence for the risk of atrial fibrillation and moderate certainty of the evidence for the risk of breast cancer.ConclusionAtrial fibrillation is not uncommon in patients with breast cancer and vice versa. There is a bidirectional association between atrial fibrillation (low certainty) and breast cancer (moderate certainty).
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Affiliation(s)
- Xiongda Yao
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qingwen Hu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiao Liu
- Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong, China
| | - Qing Ling
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yurong Leng
- The Affiliated Stomatological Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Huilei Zhao
- Department of Anesthesiology, The Third Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Peng Yu
- Department of Endocrine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Yujie Zhao
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Menglu Liu
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Renqiang Yang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- *Correspondence: Renqiang Yang
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10
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Gonçalves-Teixeira P, Costa T, Fragoso I, Ferreira D, Brandão M, Leite-Moreira A, Sampaio F, Ribeiro J, Fontes-Carvalho R. Screening, Diagnosis and Management of Atrial Fibrillation in Cancer Patients: Current Evidence and Future Perspectives. Arq Bras Cardiol 2022; 119:328-341. [PMID: 35946695 PMCID: PMC9363048 DOI: 10.36660/abc.20201362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population, carrying a high morbimortality burden, and this also holds true in cancer patients. The association between AF and cancer goes even further, with some studies suggesting that AF can be a marker of occult cancer. There is, however, a remarkable paucity of data concerning specific challenges of AF management in cancer patients. AF prompt recognition and management in this special population can lessen the arrhythmia-related morbidity and have an important prognostic benefit. This review will focus on current AF diagnosis and management challenges in cancer patients, with special emphasis on AF screening strategies and devices, and anticoagulation therapy with non-vitamin K antagonist oral anti-coagulants (NOACs) for thromboembolic prevention in these patients. Some insights concerning future perspectives for AF prevention, diagnosis, and treatment in this special population will also be addressed.
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Affiliation(s)
- Pedro Gonçalves-Teixeira
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal.,Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Telma Costa
- Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal.,Departamento de Oncologia, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Isabel Fragoso
- Unidade de Atenção Primária à Saúde Aracetti, Arazede - Portugal
| | - Diogo Ferreira
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - Mariana Brandão
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal
| | - Adelino Leite-Moreira
- Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal.,Departamento de Cirurgia Cardiotorácica, Hospital Universitário São João, Porto - Portugal.,Unidade de Pesquisa Cardiovascular (UnIC), Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - Francisco Sampaio
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - José Ribeiro
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Ricardo Fontes-Carvalho
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
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11
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Götzinger F, Reichrath J, Millenaar D, Lauder L, Meyer MR, Böhm M, Mahfoud F. Photoinduced skin reactions of cardiovascular drugs-a systematic review. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:420-430. [PMID: 35278085 DOI: 10.1093/ehjcvp/pvac017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/10/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
This systemic review aims to provide a practical overview of the prevalence, clinical manifestation, and management of adverse photoinduced skin reactions caused by frequently used cardiovascular drugs and to assess their potential relevance for skin cancer development. Data search included PubMed, Web of Science, and the Cochrane Library. A systematic review of peer-reviewed studies reporting the photosensitizing and/or skin cancer-inducing properties of common cardiovascular drugs was performed and a guide to clinical management of photoinduced skin eruptions by cardiovascular drugs was provided. Study quality was assessed for major methodological biases. A total of 58 studies were identified (i.e. 23 case reports, 14 observational studies, 10 review articles, 10 experimental studies, and 1 meta-analysis). Most commonly, drug-associated adverse photoinduced cutaneous reactions were caused by phototoxic and photoallergic mechanisms. There is evidence suggesting that amiodarone and dronedarone, thiazide diuretics, thiazide-like diuretics, angiotensin receptor blockers, dihydropyridine-type calcium channel blockers, and certain angiotensin-converting enzyme inhibitors and statins may cause photoinduced adverse cutaneous reactions. Other drugs such as anticoagulants, antiplatelets, aldosterone antagonists, and fibrates have not been linked with photosensitizing reactions or adverse cutaneous reactions. Some drugs, i.e. thiazides and thiazide-like diuretics, were associated with an increased risk of non-melanoma skin cancers (basal cell carcinoma and squamous cell carcinoma). Certain commonly used cardiovascular drugs have been associated with adverse photoinduced cutaneous reactions. If they occur, further diagnosis and treatment might be needed, depending on the severity and progress. Whether photosensitizing drugs increase the risk of skin cancer remains elusive and further randomized controlled trials are required.
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Affiliation(s)
- Felix Götzinger
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland, Saarland University, Geb. 41, Kirrbergerstraβe 100, 66424 Homburg, Germany
| | - Jörg Reichrath
- Department of Adult and Pediatric Dermatology, Venereology, Allergology, University Hospital Saarland, Saarland University, 66424 Homburg, Germany
| | - Dominic Millenaar
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland, Saarland University, Geb. 41, Kirrbergerstraβe 100, 66424 Homburg, Germany
| | - Lucas Lauder
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland, Saarland University, Geb. 41, Kirrbergerstraβe 100, 66424 Homburg, Germany
| | - Markus R Meyer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University, 66421 Homburg, Germany
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland, Saarland University, Geb. 41, Kirrbergerstraβe 100, 66424 Homburg, Germany
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland, Saarland University, Geb. 41, Kirrbergerstraβe 100, 66424 Homburg, Germany
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12
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Jackson I, Etuk AS, Jackson N. Impact of Atrial Fibrillation on Inpatient Outcomes Among Hospitalized Patients With Multiple Myeloma. Cureus 2022; 14:e25252. [PMID: 35755507 PMCID: PMC9217100 DOI: 10.7759/cureus.25252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 12/05/2022] Open
Abstract
Background Though multiple myeloma (MM) patients have been reported to have the highest risk of atrial fibrillation compared to other cancer patients, studies are lacking on the impact of atrial fibrillation on health outcomes in this population. In this study, we examined the impact of atrial fibrillation on inpatient outcomes among hospitalized patients with MM. Methodology Retrospective cohort analyses were conducted using National Inpatient Sample data from 2016 to 2018. Descriptive analyses were performed to explore the prevalence of atrial fibrillation among MM patients. Multivariable logistic and linear regression models were used to examine the association between atrial fibrillation and inpatient all-cause mortality, length of stay, and total hospital charges among hospitalized patients with MM. Results Overall, 13.1% of the patients reported having atrial fibrillation. MM patients with atrial fibrillation had 1.2 times (adjusted odds ratio (AOR) = 1.16; 95% confidence interval (CI) = 1.05-1.29) higher odds of inpatient all-cause mortality when compared to those without atrial fibrillation. They were also 1.3 times (AOR = 1.29; 95% CI = 1.23-1.35) more likely to have a length of stay of more than five days relative to five days or less. Additionally, MM patients with atrial fibrillation had $8,020 (95% CI = $5,495.2-$10,546.3) higher hospital costs when compared to their counterparts without atrial fibrillation. Stratified results by the use of anticoagulation further showed that MM patients who were not using anticoagulation had bad health outcomes, reporting higher odds of inpatient all-cause mortality (AOR = 1.40; 95% CI = 1.25-1.57), a longer length of hospital stay of more than five days (AOR = 1.44; 95% CI = 1.36-1.53), and total hospital charges (β = $14,772.5; 95% CI = $11,467.8-$18,077.3). Conclusions Our findings stress the need for monitoring and possible screening to detect atrial fibrillation in MM patients as anticoagulation helps improve mortality in these patients. Medication reconciliation remains a key component of hospital admissions/discharges and may help in decreasing the length of stay and healthcare costs.
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13
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Tufano A. Optimizing antithrombotic therapy for atrial fibrillation in cancer. Thromb Res 2022; 213 Suppl 1:S103-S106. [DOI: 10.1016/j.thromres.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 10/18/2022]
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14
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Nochioka K, Yasuda S, Sakata Y, Shiroto T, Hayashi H, Takahashi J, Takahama H, Miyata S, Shimokawa H. Prognostic impact of a history of cancer and atrial fibrillation in antithrombotic therapy for chronic heart failure. ESC Heart Fail 2022; 9:2445-2454. [PMID: 35434966 PMCID: PMC9288778 DOI: 10.1002/ehf2.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/04/2022] [Accepted: 04/04/2022] [Indexed: 11/08/2022] Open
Abstract
AIMS This study aimed to examine the prognostic significance of a history of cancer and atrial fibrillation (AF) in antithrombotic therapy for patients with chronic heart failure (CHF). METHODS AND RESULTS We enrolled consecutive 4876 CHF patients (69 ± 12 years; women, 31.9%) in our multicentre, hospital-based cohort study, the Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2), with a median follow-up of 8.7 years. Among them, 14% and 41% had a history of cancer and AF, respectively. AF patients with a history of cancer were older, more frequently men. History of cancer was not statistically associated with higher rate of composite of stroke, systemic thrombosis, and major bleeding defined by International Society on Thrombosis and Haemostasis [Fine-Gray sub-distribution hazard ratio (sHR) accounting for the competing risk of all-cause death, 0.91; 95% confidence interval (CI), 0.56-1.48; P = 0.715]. The patients with history of cancer and AF had a heightened risk for the composite of stroke, systemic thrombosis, and major bleeding (sHR, 1.64; 95% CI, 1.04-2.60; P = 0.033), especially in those aged >75 years (sHR, 2.14; 95% CI, 1.01-4.53; P = 0.046) and those with ischaemic heart disease (IHD; 2.48; 1.30-4.72; P = 0.006). Furthermore, 36% of AF patients with a history of cancer did not receive anticoagulant therapy. CONCLUSIONS The CHF patients with history of cancer and AF had higher risk for stroke, systemic thrombosis, and major bleeding, especially in the elderly and those with IHD, but considerable number of the patients did not receive anticoagulant therapy, indicating the need for better optimal anticoagulation strategy.
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Affiliation(s)
- Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Hospital, Seiryo-machi 1-1-1, Aobaku, Sendai, Miyagi, 9810933, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Hospital, Seiryo-machi 1-1-1, Aobaku, Sendai, Miyagi, 9810933, Japan
| | | | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Hospital, Seiryo-machi 1-1-1, Aobaku, Sendai, Miyagi, 9810933, Japan
| | - Hideka Hayashi
- Department of Cardiovascular Medicine, Tohoku University Hospital, Seiryo-machi 1-1-1, Aobaku, Sendai, Miyagi, 9810933, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Hospital, Seiryo-machi 1-1-1, Aobaku, Sendai, Miyagi, 9810933, Japan
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, Tohoku University Hospital, Seiryo-machi 1-1-1, Aobaku, Sendai, Miyagi, 9810933, Japan
| | - Satoshi Miyata
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Hospital, Seiryo-machi 1-1-1, Aobaku, Sendai, Miyagi, 9810933, Japan.,International University of Health and Welfare, Otawara, Japan
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15
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Murtaza M, Baig MMA, Ahmed J, Serbanoiu LI, Busnatu SS. Higher Mortality Associated With New-Onset Atrial Fibrillation in Cancer Patients: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:867002. [PMID: 35498001 PMCID: PMC9047948 DOI: 10.3389/fcvm.2022.867002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/08/2022] [Indexed: 12/30/2022] Open
Abstract
AimThis research was conducted to evaluate the mortality outcome of cancer patients with new-onset atrial fibrillation. We also aimed to assess if there was any confounding relation between the mortality of these patients and surgical intervention.Materials and MethodsA systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 7 February 2022. All statistical analyses were conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. Only those studies that involved cancer patients without pre-existing atrial fibrillation were selected, and mortality rate was compared between the patients who developed atrial fibrillation and those who did not. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in the odds ratio (OR) and the corresponding 95% confidence interval (CI).ResultsEighteen studies were selected for meta-analysis. Statistical analysis showed that the cancer patients who subsequently developed atrial fibrillation had a significantly higher mortality rate as compared to those who did not (OR = 1.90 [1.65, 2.19]; p < 0.00001; I2 = 100%). We also separately analyzed the mortality risk in the surgery group and the non-surgery group. Statistical analysis showed that there was significantly higher mortality rate associated with new-onset atrial fibrillation in cancer patients in the surgery group (OR= 3.68 [2.29, 5.94]; p < 0.00001; I2 = 61%) as well as in the non-surgery group (OR = 1.64 [1.39, 1.93]; p < 0.00001; I2 = 100%).ConclusionCancer patients, who subsequently developed atrial fibrillation, had a higher mortality rate as compared to those cancer patients who did not develop atrial fibrillation. A higher mortality rate was seen in both surgical and non-surgical subgroups. This implies that extra care and specific measures must be taken in the management of cancer patients with new-onset atrial fibrillation.
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Affiliation(s)
- Minha Murtaza
- Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mirza Mehmood Ali Baig
- Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
- *Correspondence: Mirza Mehmood Ali Baig
| | - Jawad Ahmed
- Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Liviu Ionut Serbanoiu
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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16
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Emmanuel KE, Jensen N, Anyanwagu U. Refractory Atrial Fibrillation With Rapid Ventricular Rate in a Patient With Small Cell Carcinoma of the Lung Encasing the Right Pulmonary Artery: A Case Report and Insight Into Therapeutic Options. Cureus 2021; 13:e16027. [PMID: 34277299 PMCID: PMC8269994 DOI: 10.7759/cureus.16027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/05/2022] Open
Abstract
Atrial fibrillation is the most common sustained cardiac arrhythmia. While there have been reports of atrial fibrillation caused by the compression of pulmonary veins, we have not found reports of atrial fibrillation caused by the compression of the pulmonary artery. This report highlights the possible pathophysiology and management of atrial fibrillation in a patient with small cell lung cancer. The patient was admitted for hyponatremia secondary to syndrome of inappropriate antidiuretic hormone (SIADH) but subsequently developed tachycardia which progressed to atrial flutter and atrial fibrillation. Antiarrhythmics were ineffective until the patient received his first palliative chemotherapy for his small cell lung cancer. Subsequently, rate control was achieved with sotalol, with eventual conversion back to sinus rhythm. Management of atrial fibrillation is complex and sometimes depends on the underlying etiology. Early chemotherapy, in addition to antiarrhythmic drugs, may be beneficial in the management of patients with small cell lung cancer and atrial fibrillation. The CHA2DS2-VASc score does not take active malignancy into account and anti-coagulation should be evaluated on a case-by-case basis in this patient population.
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Affiliation(s)
- Kelechi E Emmanuel
- Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, USA
| | - Nichole Jensen
- Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, USA
| | - Uche Anyanwagu
- Family Medicine, University of Nottingham, Royal Derby Hospital, Nottingham, GBR
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