Elsevier

International Journal of Cardiology

Volume 296, 1 December 2019, Pages 81-86
International Journal of Cardiology

Risk and predictors of subsequent cancers of patients with newly-diagnosed atrial fibrillation — A nationwide population-based study

https://doi.org/10.1016/j.ijcard.2019.08.021Get rights and content

Highlights

  • The incidence of cancer was 1.65%/year for patients with atrial fibrillation (AF).

  • Compared to general population, AF patients had a higher risk of cancer.

  • Several clinical factors could predict the developments of cancers for AF patients.

Abstract

Aims

Patients with atrial fibrillation (AF) may be at higher risk for cancer, possibly due to the presence of coexisting risk factors. In this study, we investigate the magnitude and predictors of this potential risk within a population-based study.

Methods and results

The study cohort included 332,555 AF patients aged ≥20 years without past history of cancer. Standardized incidence ratio (SIR) was used as a measure of relative risk, comparing observed cancer incidence among patients with AF with that expected based on cancer incidence in the Taiwanese population. During the observation period, 22,911 incident cancers occurred with an incidence of 1.65%/year. Compared with the general population, AF patients had a significantly higher cancer risk with a SIR of 1.37 (95%CI = 1.36–1.39). Patients with new-onset AF had an elevated cancer risk which was highest within 1 year (SIR = 2.30; 95%CI, 2.25–2.36) and persisted beyond 10 years after AF was diagnosed (SIR = 1.18; 95%CI, 1.11–1.25). Age ≥ 65 years, male gender, hypertension, diabetes, chronic obstructive pulmonary disease (COPD) and liver cirrhosis were significantly associated with development of cancers among AF patients. The hazard ratio of cancers increased from 1.40 (95%CI = 1.28–1.53) for patients having 1 risk factor to 5.14 (95%CI = 4.03–6.06) for patients with 6 risk factors, in comparison to those without any risk factors.

Conclusion

In the nationwide cohort study, we show that AF patients had a higher risk of cancer. Age, male gender, hypertension, diabetes, COPD and liver cirrhosis are important risk factors of cancer among AF patients. Prompt and detailed examinations may be considered for incident AF patients with multiple risk factors to early detect the occult malignancy.

Section snippets

Background

Atrial fibrillation (AF) is a disease of the elderly, with an increasing prevalence and incidence with age. AF not only increases the risk of stroke, but also increased the risk of death by 1.5 fold in males and 1.9-fold in females in the Framingham Heart Study [1]. Although cardiovascular diseases represented the most common cause of mortality among AF patients, cancer also accounted for approximately 11% of all deaths in patients with AF in a recent pooled analysis of 4 randomized trials of

Methods

The data, analytic methods, and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure.

Results

The baseline characteristics of study population are shown in Table 1. The mean age of AF patients was 70.8 ± 13.1 years, and 55.2% were men. Hypertension is the most common comorbidity which is prevalent among 68.5% of patients. Overall, the cohort was observed for 1385,140 person-years with a median follow-up of 3.1 years.

Main findings

To our knowledge, this is the largest observational cohort of AF patients in which the absolute and relative risk of cancer and its predictors were investigated. Our principal findings are as follows: (i) AF patients had an increased risk of almost every kind of cancer, which was consistently observed in males and females; (ii) the increased risk of cancer was highest within 1 year and persisted beyond 10 years after AF was diagnosed; and (iii) several clinical factors were identified to be

Conclusion

In the nationwide cohort study, we show that the risk of cancer was higher for AF patients compared to that of general population. The relative risk was higher early after an AF diagnosis but persisted in the long term. Age, male gender, hypertension, diabetes, chronic obstructive pulmonary diseases and liver cirrhosis are independent risk factors of cancer among AF patients. Prompt and detailed examinations may be considered for incident AF patients with multiple risk factors to early detect

Acknowledgments

  • 1.

    This work was supported in part by grants from the Ministry of Science and Technology (MOST 107-2314-B-075-062-MY3), Research Foundation of Cardiovascular Medicine and Szu-Yuan Research Foundation of Internal Medicine, Taipei, Taiwan.

  • 2.

    This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health and managed by National Health Research Institutes. The interpretation and conclusions contained

Declaration of Competing Interest

None.

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    1

    Contributed equally to this study.

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