Impact of cardiovascular events and major bleeding in mortality in patients with atrial fibrillation and active lung cancer: data from a multicentre, retrospective, observational study
Authors: Ruiz Ortiz M , Piserra Lopez-Fernandez De Heredia A , Mesa Rubio D , Delgado Ortega M , Moreno Vega A , Alarcon De La Lastra Cubiles I , Sanchez Fernandez J J , Calvete Cadenas J , Diaz Exposito A , Perez Cabeza A , Trigo Perez J M , Fernandez Valenzuela I , Chaparro Munoz M , Carrillo Bailen M , Torres Llergo J 
Published: November 2023

Abstract

Background
Lung cancer has a poor prognosis for most patients, as it is frequently diagnosed in advanced tumour stages. Real world observational data on the impact of major cardiovascular events (MACE) and major bleedings (MB) in the prognosis of patients with atrial fibrillation (AF) and active lung cancer are very limited.

Purpose
Our aim was to investigate the impact of MACE and MB in mortality in this population.

Methods
We used data from CANAC-FA Registry (Active Cancer and AF, in Spanish, CÁNcer ACtivo y Fibrilación Auricular), an observational, multicentre, retrospective study. The medical records of all subjects attended at the outpatient oncology clinics solely or mainly attending lung cancer patients from January 1st, 2017 to December 31st, 2019 in five tertiary university hospitals in the south of Spain were reviewed. The first visit to the oncology clinic with AF diagnosis during the first year after the lung cancer detection was considered the basal visit. Follow up period ended at December 31st, 2021. MACE (hospital admission for cardiovascular causes) and MB (International Society of Thrombosis and Haemostasis definition) were registered, and impact on survival was assessed for the whole series and according to tumour stage.

Results
Among 6984 patients, 269 presented active lung cancer and AF (3.9%). Mean age was 71±8 years, and 91% were male. Tumour stage was I, II, III and IV in 11%, 11%, 34% and 45% of the study sample, respectively. Anticoagulants were prescribed to 84% of the patients. After up to 46 months of maximum follow-up, 33 patients presented 40 MACE (13 heart failure admissions, 9 pulmonary embolisms, 5 strokes, 5 severe symptomatic arrhythmias, 4 deep vein thrombosis, 2 transient ischemic attacks, 2 systemic embolisms and 1 acute coronary syndrome), 16 patients had a MB and 186 died. However, two years’ mortality was similar in those patients with MACE or MB in follow-up versus those without them, in the whole of series (79% versus 73%, p=0.79, figure A), and in those with advanced cancer stages (III-IV, 89% versus 85%, p=0.39, figure B). In spite of that, in those patients with early tumour stages (I-II), two years’ mortality was significantly higher in those who suffered MACE or MB than in those free of both of them (85% versus 25%, p=0.01, figure C), and this difference remained after adjusting by other independent predictors of mortality (Hazard Ratio 11.08 [2.69-45.58], p=0.001).

Conclusions
In patients with AF and active lung cancer, patients with MACE and MB in follow up had similar mortality than those without them in the subgroup with advanced cancer stages. However, mortality was significantly higher in patients with these complications versus those without them in the subgroup with early cancer stages. This information could be useful for individualizing therapeutic efforts in this population.Impact of events in survival