Risk of Atrial Fibrillation According to Cancer Type: A Nationwide Population-Based Study

Jun Pil Yun; Eue-Keun Choi; Kyung-Do Han; Sang Hyun Park; Jin-Hyung Jung; Sang Hyeon Park; Hyo-Jeong Ahn; Jae-Hyun Lim; So-Ryoung Lee; Seil Oh

doi:10.1016/j.jaccao.2021.03.006

Risk of Atrial Fibrillation According to Cancer Type: A Nationwide Population-Based Study

JACC CardioOncol. 2021 Jun 15;3(2):221-232. doi: 10.1016/j.jaccao.2021.03.006. eCollection 2021 Jun.

Authors

Affiliations

¹ Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
² Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
³ Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Abstract

Background: Patients with cancer have an increased risk of atrial fibrillation (AF). However, there is a paucity of information regarding the association between cancer type and risk of AF.

Objectives: This study sought 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 2016. Age- and sex-matched noncancer control subjects (1:2; n = 1,633,663) were also selected. Newly diagnosed AF was identified based on the type of cancer.

Results: During a median follow-up of 4.5 years, AF was newly diagnosed in 25,356 patients with cancer (6.6 per 1,000 person-years). In multivariable Fine and Gray's regression analysis, cancer was an independent risk factor for incident AF (adjusted subdistribution hazard ratio [aHR]: 1.63; 95% confidence interval [CI]: 1.61 to 1.66). Multiple myeloma showed a higher association with incident AF (aHR: 3.34; 95% CI: 2.98 to 3.75). Esophageal cancer showed the highest risk among solid cancers (aHR: 2.69; 95% CI: 2.45 to 2.95), and stomach cancer showed the lowest association with AF risk (aHR: 1.27; 95% CI 1.23 to 1.32).

Conclusions: Although patients with cancer were found to have a higher risk of AF, the impact on AF development varied by cancer type.

Keywords: AF, atrial fibrillation; CI, confidence interval; CKD, chronic kidney disease; CNS, central nervous system; CVD, cardiovascular disease; DM, diabetes mellitus; HR, hazard ratio; ICD-10, International Classification of Diseases–10th Revision; IQR, interquartile range; NHIS, National Health Insurance Service; atrial fibrillation; cancer; epidemiology; type of cancer.