Clinical Profiles of Atrial Fibrillation Patients With or Without Cancer: Analysis from the Jordan Atrial Fibrillation Study

Author(s): Ismail Hamam, Zaid Abdulelah, Ibrahim Jarrad, Alia Khamis, Muyasar Amro, Ayat Taqash, Hadeel Abdelkhaleq, Abdellbaset Al-Khatib, and Ayman Hammoudeh

Background: Atrial Fibrillation (AF) is the most prevalent arrhythmia and is associated with high morbidity and mortality. Cancer can predispose to AF directly or through adverse effects of specific anti-cancer agents.

Methods: A total of 2036 Consecutive adult patients with AF in 19 hospitals and 11 outpatient clinics in Jordan were enrolled in the Jordan AF study from May 2019 to October 2020 and followed prospectively for one year. Clinical and epidemiological characteristics of patients with cancer were compared to those without cancer. Results: Of the 2036 patients enrolled, 133 (6.5%) had cancer; with gastrointestinal cancers being the most common type (21%). Patients with cancer were older (70.6±10 vs. 67.8±1 P=0.041) tends to have fewer symptoms at presentation, have more permanent AF (42.6% vs. 29.4%, P=0.0005), and are more likely to have left ventricular hypertrophy (61.6% vs. 37.7%, p<0.001) and pulmonary hypertension (20.2% vs. 9.0%, p=0.002). These patients were more likely to be prescribed LMWH (21.3% vs. 1.5%, p<0.0001). And less likely to receive DOACs (40.7% vs. 59.1%, p< 0.001), cardio-protective and anti-arrhythmic agents compared to those without cancer. After one year of follow up all-cause mortality and major bleeding were significantly higher in the cancer group (32.8% vs. 13.3% p<0.0001) (6.3% vs. 2.4% P=0.022) respectively.

Conclusion: Middle Eastern patients with AF and cancer were older and had more permanent AF than patients without cancer. They were more likely to be prescribed LMWH, and less likely to receive DOACs and cardio-protective agents. They have significantly higher all-cause mortality and major bleeding at one-year follow-up.