Thirty-day mortality in ED patients with new onset atrial fibrillation and actively treated cancer - 17/08/15

Doi : 10.1016/j.ajem.2015.07.033

Thomas Lardaro, MD, MPH, Wesley H. Self, MD, MPH, Tyler W. Barrett, MD, MSCI ^{^⁎}
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN

^⁎Corresponding author at: Department of Emergency Medicine, Vanderbilt University School of Medicine, 703 Oxford House, 1313 21st Ave South, Nashville, TN 37232-4700. Tel.: +1 615 936 0253; fax: +1 615 936 1316.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 17 August 2015

Abstract

Objectives

Studies suggest that inflammatory, autonomic, and coagulation alterations associated with cancer may increase incident atrial fibrillation (AF). New-onset AF is associated with increased mortality in other nonneoplastic disease processes. We investigated the association of active cancer with 30-day mortality in emergency department (ED) patients with new-onset AF.

Methods

We conducted an analysis within an observational cohort study at a tertiary care hospital that included ED patients with new-onset AF. The exposure variable was presence of active cancer. We defined active cancer as the patient received chemotherapy, radiotherapy, or recent cancer-related surgery within 90 days of the ED visit. The primary outcome was 30-day mortality. Logistic regression was used to analyze the association between cancer status and 30-day mortality adjusting for patient age and sex.

Results

During the 5.5-year study period, 420 patients with new-onset AF were included in our cohort, including 37 (8.8%) with active cancer. Patients with active cancer had no clinically relevant differences in their hemodynamic stability. Among the 37 patients with active cancer, 9 (24%) died within 30 days. Of the 383 patients without active cancer, 11 (3%) died within 30 days. After adjusting for age and sex, active cancer was an independent predictor of 30-day mortality, with an adjusted odds ratio of 10.8 (95% confidence interval, 3.8-31.1).

Conclusions

Among ED patients with new-onset AF, active cancer appears to be associated with 11-fold increased odds of 30-day mortality; new-onset AF may represent progressive organ dysfunction leading to an increased risk of short-term mortality in patients with cancer.

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Plan

☆	Conflicts of Interest/Disclosures: There are no conflicts of interest in connection with this submission, or are there any copyright constraints. No industry financial support or compensation has been or will be received for conducting this study. Dr Barrett serves as a scientific consultant for Red Bull GmbH, Fuschl am See, Salzburg (Austria), and Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, and has received research funding from Alere, Boehringer Ingelheim, and Janssen. Dr Barrett is a member of the American Heart Association's The Guideline Advantage Research Subcommittee and serves on the Editorial Board for Annals of Emergency Medicine. Dr Self is a paid advisor for BioFire Diagnostics, Inc, and Venaxis, Inc, and has received research funding from CareFusion, BioMerieux, Affinium Pharmaceuticals, Astute Medical, BRAHMS GmbH, Pfizer, Rapid Pathogen Screening, Venaxis, and BioAegis. Dr Lardaro has no financial declarations and no potential conflicts of interest.
☆☆	Funding Sources: Dr Barrett and this study are funded by NIH Grant K23 HL102069 from the National Heart, Lung and Blood Institute, Bethesda, MD. Dr Self is supported by NIH Grant K23GM110469 from the National Institute of General Medical Sciences. This study was also supported by Grant UL1 TR000445 from the National Center for Advancing Translational Sciences/NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
★	Role of the Sponsors: The funding organizations had no role in the design and conduct of the study; the collection, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.