Different risk of atrial fibrillation according to the type of cancer: a nationwide population-based study

Abstract

Abstract Introduction Patients with malignancies are known to have an increased risk of atrial fibrillation (AF). However, there is a paucity of information regarding the cancer type and the risk of AF. We aimed to evaluate the risk of AF according to the type of cancer. Methods We enrolled 816,811 patients who were diagnosed with cancer from the Korean National Health Insurance Service database between 2009 and 2014. Age and sex-matched non-cancer control subjects (1:2, n=1,633,663) were selected and compared with patients with malignancy. Newly diagnosed nonvalvular AF was identified using the claims data. Besides, we performed a sensitivity analysis using lag periods from cancer diagnosis to AF for more than 1 year and more than 5 year. Results During a mean follow up of 4.7 years, AF was newly diagnosed in 25,356 patients with cancer (6.6 per 1000 person-years) whereas 31,801 patients in the control group (3.6 per 1000 person-years). In multivariate Cox regression analysis, cancer was an independent risk factor for incident AF (HR 1.97; 95% CI 1.94–2.00). Hematologic malignancies show higher correlation with incident AF (multiple myeloma, the hazard ratio (HR) 4.57; 95% confidence interval (CI) 4.08–5.12; leukemia, HR 4.15; 95% CI 3.75–4.59). Malignancies of the nervous system, esophagus, lung, and pancreatic cancer show higher risks of AF more than 3 times than control, whereas prostate cancer shows the lowest association with AF risk (HR 1.36; 95% CI 1.29–1.44). In subgroup analysis, the effect of cancer on AF development was more prominent in patients with younger age (<65 years) and fewer comorbidities (hypertension, diabetes mellitus, chronic kidney disease, dyslipidemia, and obesity). In sensitivity analysis using lag periods, the strength of risks of AF decline with time from cancer diagnosis but remain significant (“>1yr” HR 1.77; 95% CI 1.74–1.81; “>5yrs” HR 1.12; 95% CI 1.07–1.16). However, AF risk was more diverse according to the types of cancers in patients surviving above five years. Multiple myeloma, leukemia, lymphoma, ovarian, liver, and lung cancer show higher risks of AF than control while other types of cancer show no significant association with AF incidence after five years from a cancer diagnosis. Conclusion Although patients with cancer showed a higher risk of AF, but the impact on AF development was diverse among cancer types. Hematologic malignancies showed the highest risk of AF, and the risk was maintained up to 5 year after diagnosis of cancer. Therefore it would be reasonable to screen AF especially in those malignancies with high-risk for AF. Different AF risk in cancer patients Funding Acknowledgement Type of funding source: None