Key result
Atrial fibrillation in CLL/SLL patients increased the risk of heart failure (HR 2.82), bleeding (HR 1.67), stroke (HR 1.47), and 1-year inpatient utilization (OR 2.28; all P<0.0001).
Why the study?
The real-world impact of atrial fibrillation on cardiovascular outcomes and healthcare resource utilization in patients with CLL/SLL overall, by age, and by Bruton tyrosine kinase inhibitor therapy required evaluation.
Does atrial fibrillation increase the risk of subsequent cardiovascular outcomes (stroke, bleeding, heart failure) and healthcare resource utilization in adults with newly diagnosed CLL/SLL, and do these outcomes differ among first-line Bruton tyrosine kinase inhibitors?
Cohort (n=233,362)
Yes
Does atrial fibrillation increase the risk of subsequent cardiovascular outcomes (stroke, bleeding, heart failure) and healthcare resource utilization in adults with newly diagnosed CLL/SLL, and do these outcomes differ among first-line Bruton tyrosine kinase inhibitors?
Answers are grounded in this paper and cite their sources.
In a large US real-world cohort of patients with CLL/SLL, developing atrial fibrillation within 1 year of diagnosis substantially increased the risk of subsequent stroke, bleeding, heart failure, and inpatient hospitalization, while first-line treatment with zanubrutinib was associated with lower rates of AFib and downstream cardiovascular complications compared with acalabrutinib and ibrutinib.
Purpose: This study evaluated the impact of atrial fibrillation (AFib) on cardiovascular (CV) outcomes and healthcare resource utilization (HCRU) in patients with CLL/SLL overall, by age, and by Bruton tyrosine kinase inhibitor (BTKi) therapy.Materials and Methods: This retrospective study used the US Symphony database to identify newly diagnosed adults with CLL/SLL (2014)(2015)(2016)(2017)(2018)(2019)(2020)(2021)(2022)(2023)(2024).Occurrence of AFib was assessed for 1 year after diagnosis.Subsequent CV outcomes and HCRU were compared, with subgroup analyses conducted in patients ≥65 years.Exploratory analyses compared outcomes among first-line BTKi (ibrutinib, acalabrutinib, or zanubrutinib).Results: Among 233,362 CLL/SLL patients, 13.1% had AFib within 1 year.Significantly higher proportions of patients with AFib had subsequent stroke (14.3% vs 8.9%), bleeding (27.9% vs 19.1%), and heart failure (54.5% vs 18.9%) versus without AFib (P<.0001), and had 128% higher odds to incur inpatient service (P<.0001).Results were consistent in elderly patients.Rates of AFib within 1 year of first-line BTKi treatment were 11% (zanubrutinib), 13% (acalabrutinib), and 16% (ibrutinib) (P<.0001).Compared with ibrutinib and acalabrutinib, a lower proportion of patients with AFib receiving zanubrutinib had subsequent stroke (12.2% vs 9.4% vs 4.8%, respectively), bleeding (27.4% vs 21.5% vs 17.4%), and heart failure (50.9% vs 45.6% vs 39.6%) (P<.002).Compared with zanubrutinib, the odds of inpatient HCRU within 1 year were 29% higher with acalabrutinib (P=.0005) and 69% higher with ibrutinib (P<.0001).Conclusions: Findings highlight significant real-world CV and HCRU burden incurred by CLL/SLL patients with AFib.Zanubrutinib appears to offer potentially lower rates of AFib-related CV and HCRU complications.
No takes yet. Share an insight, caveat, or question.
Ermann et al. (2026) conducted a cohort in Chronic lymphocytic leukemia / small lymphocytic lymphoma (CLL/SLL) (n=233,362). Atrial fibrillation (AFib) within 1 year of CLL/SLL diagnosis vs. Patients with CLL/SLL without atrial fibrillation was evaluated on Subsequent heart failure (HR 2.82, 95% CI 2.76-2.88, p=<0.0001). Atrial fibrillation in CLL/SLL patients increased the risk of heart failure (HR 2.82), bleeding (HR 1.67), stroke (HR 1.47), and 1-year inpatient utilization (OR 2.28; all P<0.0001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: