What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension and matched controls (n=1045). Intervention: Cancer vs. No cancer. Primary outcome: New-onset atrial fibrillation requiring hospitalization (HR 2.47, 95% CI 1.57-3.88, p=<0.001).

October 5, 2018Open Access

Cancer increases the risk of atrial fibrillation during long-term follow-up (OPERA study)

Q: What are the key findings of this study?

Cancer independently increased the risk of developing atrial fibrillation by more than twofold compared to subjects without cancer (HR 2.47).

HKHelena KattelusOulu University Hospital YKY. Antero KesäniemiBroad Institute HHHeikki V. HuikuriElectrophysiology

Key Result

Cancer independently increased the risk of developing atrial fibrillation by more than twofold compared to subjects without cancer (HR 2.47).

Study Design

Type

Cohort (n=1,045)

Multicenter

Structured PICO

Does cancer increase the risk of developing atrial fibrillation in a general cohort?

Population

1,045 middle-aged hypertensive subjects and matched controls were followed for a mean of 16.3 years to assess the risk of developing atrial fibrillation.

Exposure

Cancer diagnosis (exposure)

Comparator

Subjects without cancer

Outcome

Atrial fibrillation (including atrial flutter) identified via National Death Registry and/or hospital discharge registryhard clinical

Cancer acts as an independent risk factor for the development of atrial fibrillation over long-term follow-up.

Main Result

Hazard Ratio: 2.47 (95% CI 1.57–3.88)

Absolute Event Rate: 19.2% vs 8.7%

p-value: p=<0.001

Limitations

Lack of specific data on cancer subjects, such as the type of cancer and the specific treatment modalities given (e.g., surgery or cytotoxic drugs).

Abstract

INTRODUCTION: Relation between atrial fibrillation (AF) and cancer is known but not very well understood. The purpose of this prospective study was to find out whether subjects with cancer were at greater risk of AF than subjects without cancer. MATERIALS AND METHODS: The study was based on the OPERA (Oulu Project Elucidating Risk of Atherosclerosis) material and had 1045 subjects and the mean follow-up time of 16.3 years. During the follow-up AF and cancer diagnosis were made (atrial flutter included) if these events were listed in the National Death Registry and/or hospital discharge registry. RESULTS: In this study 130 subjects (12%) had cancer and 19% of these had AF, whereas only 9% of those without cancer experienced AF during the follow-up (p<0.001). Subjects in the cancer group had greater probability of developing atrial fibrillation during the follow-up time in comparison to the subjects without cancer (Hazard ratio (HR) 2.47 (95%CI) 1.57-3.88) in multivariate model including relevant confounding factors. CONCLUSION: The main finding of this OPERA study was that cancer is an independent risk factor of atrial fibrillation. Still it remains unclear whether this association is causative or whether cancer and atrial fibrillation just share the same pathophysiologic mechanisms.

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