Background. Atrial fibrillation (AF) is a frequent comorbidity among cancer patients. Observational studies suggested a worse prognosis in cancer patients with AF admitted to cardiology wards; however, data on the emergency department (ED) setting remain scare. Ginvan that cancer patients present a particularly vulnerable subgroup of patients managed in the ED this study aimed to evaluate the prevalence and outcomes in cancer patients presenting in an ED setting using data from an 11-year registry.
Methods. This single-centre retrospective observational study, used data from the Heidelberg Registry of Atrial Fibrillation (HERA-FIB) stratified by presence of cancer. Patients were consecutively included within HERA-FIB when presenting with the diagnosis of atrial fibrillation to the emergency department (ED) of the University Hospital of Heidelberg between June 2009 and March 2020. Diagnosis for known cancer was related to outcome parameters including a composite EP consisting of all-cause mortality, stroke, major bleeding and myocardial infarction (MI) and individual endpoints, which were retrospectively accessed using a sequential follow-up.
Results. Among 10,222 AF patients included within HERA-FIB 1,544 (15.1%) patients had a diagnosis of cancer when presenting to the ED (Fig. 1). Patients with cancer and AF were older mean age: 77 (IQR 71-82) years compared to non-cancer patients and showed elevated cardiac biomarkers including hs-cTnT and NTproBNP compared to non-cancer patients. Patients with known cancer showed higher Hazard ratios (HR) for the composite endpoint (HR: 1.68 95%CI_ 1.51-1.87, p<0.0001). Here, cancer patients showed a higher all-cause mortality: 1.90 (95%CI: 1.68-2.15), p<0.0001, as well as major bleeding events HR: 1.68 (95%CI 1.30-2.16), p=0.0001. No difference could be observed for stroke (Log Rank p=0.6198) and MI (Log Rank p=0.3632).
Conclusions. Patients presenting with the diagnosis of cancer to an ED represent a substantial proportion of AF patients. Cancer patients showed a worse clinical outcome including higher risks for bleeding and mortality. Data from our study underlines the need for individualized management strategies and careful anticoagulation in this vulnerable patient subgroup.
