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Am J Emerg Med. 2015 Oct;33(10):1483-8. doi: 10.1016/j.ajem.2015.07.033. Epub 2015 Jul 21.

Thirty-day mortality in ED patients with new onset atrial fibrillation and actively treated cancer.

Author information

1
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN.
2
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: tyler.barrett@vanderbilt.edu.

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.

PMID:
26283615
PMCID:
PMC4581961
DOI:
10.1016/j.ajem.2015.07.033
[Indexed for MEDLINE]
Free PMC Article

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