In the Journals

AF management suboptimal in patients with history of cancer

Wesley O'Neal
Wesley T. O’Neal

Patients with atrial fibrillation and a history of active or remote cancer were less likely to have early cardiology involvement after a cancer diagnosis or fill a prescription for oral anticoagulant compared with those without a history of cancer, according to a study published in the Journal of the American College of Cardiology.

“Overall, our data suggest that suboptimal antithrombotic care exists in AF patients who have a history of cancer,” Wesley T. O’Neal, MD, MPH, cardiology fellow at Emory University School of Medicine, said in a press release. “The decision to initiate antithrombotic therapy or refer to a cardiology provider should be individualized to the patient, but our data suggest that cardiology providers positively influence outcomes among these patients.”

AF and cancer history

Researchers analyzed data from 388,045 patients (mean age, 68 years; 59% men) from 2009 to 2014 with nonvalvular AF, 17% of whom had a history of cancer (mean age, 74 years; 40% women), including lung, colon, prostate, breast, hematologic, pancreatic and other cancers.

Outpatient provider visits were identified by cardiology and primary care outpatient claims. Filled outpatient pharmaceutical claims were used to identify oral anticoagulants that were used during the study period, including warfarin and direct oral anticoagulants.

Information on comorbidities were also assessed in the study, including hypertension, HF, stroke, diabetes, peripheral artery disease, MI, liver disease, kidney disease, bleeding history and alcohol use.

The main outcome variable of interest was hospitalization for ischemic stroke after an AF diagnosis. Other outcomes of interest included hospitalization for HF, major bleeding events, MI and hospitalization for AF. Patients were followed up for a mean of 1.1 years after an AF diagnosis.

Cardiology involvement

Patients with a history of cancer were less likely to have cardiology involvement vs. those without a history of cancer (54% vs. 62%; RR = 0.92; 95% CI, 0.91-0.93). These patients were also less likely to fill anticoagulation prescriptions (RR = 0.89; 95% CI, 0.88-0.9). Results were similar in patients with colon, prostate, lung, hematologic and pancreatic cancers.

Patients with a history of cancer who were seen by a cardiology provider near the time of their diagnosis were more likely to fill anticoagulant prescriptions vs. those who were not seen by a cardiology provider (RR = 1.48; 95% CI, 1.45-1.52).

During follow-up, patients with a history of cancer who were seen by a cardiology provider had a reduced risk for ischemic stroke compared with those who did not see a cardiology provider (HR = 0.89; 95% CI, 0.81-0.99) without an increased risk for bleeding (HR = 1.04; 95% CI, 0.95-1.13).

Similar results for the risk for outcomes were seen when patients were stratified by active vs. remote history of cancer.

“As the number of cancer survivors grows in coming decades due to improvements in the detection and treatment of certain cancers, a simultaneous increase in patients with AF and a history of cancer is expected,” O’Neal and colleagues wrote. “Accordingly, the care for AF patients with a history of cancer will pose a challenge for clinicians, especially as AF patients with a history of cancer possibly have a negative perception regarding the benefit of certain AF therapies (eg, anticoagulation). This possibly explains the suboptimal rates of oral anticoagulant prescription fill observed for patients with a history of cancer.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.

Wesley O'Neal
Wesley T. O’Neal

Patients with atrial fibrillation and a history of active or remote cancer were less likely to have early cardiology involvement after a cancer diagnosis or fill a prescription for oral anticoagulant compared with those without a history of cancer, according to a study published in the Journal of the American College of Cardiology.

“Overall, our data suggest that suboptimal antithrombotic care exists in AF patients who have a history of cancer,” Wesley T. O’Neal, MD, MPH, cardiology fellow at Emory University School of Medicine, said in a press release. “The decision to initiate antithrombotic therapy or refer to a cardiology provider should be individualized to the patient, but our data suggest that cardiology providers positively influence outcomes among these patients.”

AF and cancer history

Researchers analyzed data from 388,045 patients (mean age, 68 years; 59% men) from 2009 to 2014 with nonvalvular AF, 17% of whom had a history of cancer (mean age, 74 years; 40% women), including lung, colon, prostate, breast, hematologic, pancreatic and other cancers.

Outpatient provider visits were identified by cardiology and primary care outpatient claims. Filled outpatient pharmaceutical claims were used to identify oral anticoagulants that were used during the study period, including warfarin and direct oral anticoagulants.

Information on comorbidities were also assessed in the study, including hypertension, HF, stroke, diabetes, peripheral artery disease, MI, liver disease, kidney disease, bleeding history and alcohol use.

The main outcome variable of interest was hospitalization for ischemic stroke after an AF diagnosis. Other outcomes of interest included hospitalization for HF, major bleeding events, MI and hospitalization for AF. Patients were followed up for a mean of 1.1 years after an AF diagnosis.

Cardiology involvement

Patients with a history of cancer were less likely to have cardiology involvement vs. those without a history of cancer (54% vs. 62%; RR = 0.92; 95% CI, 0.91-0.93). These patients were also less likely to fill anticoagulation prescriptions (RR = 0.89; 95% CI, 0.88-0.9). Results were similar in patients with colon, prostate, lung, hematologic and pancreatic cancers.

Patients with a history of cancer who were seen by a cardiology provider near the time of their diagnosis were more likely to fill anticoagulant prescriptions vs. those who were not seen by a cardiology provider (RR = 1.48; 95% CI, 1.45-1.52).

During follow-up, patients with a history of cancer who were seen by a cardiology provider had a reduced risk for ischemic stroke compared with those who did not see a cardiology provider (HR = 0.89; 95% CI, 0.81-0.99) without an increased risk for bleeding (HR = 1.04; 95% CI, 0.95-1.13).

Similar results for the risk for outcomes were seen when patients were stratified by active vs. remote history of cancer.

“As the number of cancer survivors grows in coming decades due to improvements in the detection and treatment of certain cancers, a simultaneous increase in patients with AF and a history of cancer is expected,” O’Neal and colleagues wrote. “Accordingly, the care for AF patients with a history of cancer will pose a challenge for clinicians, especially as AF patients with a history of cancer possibly have a negative perception regarding the benefit of certain AF therapies (eg, anticoagulation). This possibly explains the suboptimal rates of oral anticoagulant prescription fill observed for patients with a history of cancer.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.