Abstract 18761: Predicting Stroke in Patients With Cancer and Atrial Fibrillation: A Cohort Study
Introduction: Patients with cancer, a known hypercoagulable state, have a higher prevalence of stroke and atrial fibrillation (AF). Stroke prediction risk scores, developed in general medical populations, have not been validated in patients with cancer and AF and role of cancer-specific factors is unknown.
Objective: To identify unique risk factors and evaluate validity of CHADS2 and CHA2DS2-VASc scores to predict risk of stroke and mortality.
Methods: We conducted a retrospective cohort study of patients with cancer and concomitant AF at the Cleveland Clinic from 2008-2014. Data were gathered from tumor registry and electronic medical records. Outcomes, CHADS2 and CHA2DS2-VASc scores were calculated from date of cancer diagnosis. Outcomes included ischemic stroke and mortality. Prognostic factors were identified with Fine & Gray regression for stroke and Cox proportional hazards analysis for survival.
Results: Study population comprised 2,037 patients. Mean age was 70 ±11 years, 64% were male, 68% had hypertension and 35% had known vascular disease. Genitourinary cancers were the most common (29%) followed by gastrointestinal (GI) (18%). Overall, 52% had CHADS2 ≥ 2. Seventy-four patients (3.6%) developed stroke at a median of 6.4 months after cancer diagnosis (0, 93) with overall stroke risk of 1.9/100 patient years. Increased CHADS2 score was associated with stroke (HR 1.41; 95% CI 1.19-1.67; p <0.001), stronger than the association for CHA2DS2-VASc (HR 1.26; 95% CI 1.11-1.43; p <0.001). Other significant factors included primary cancer site (hematologic, GI and skin[HR 2.69; 95% CI 1.29-5.59; p=0.008]) and antiplatelet therapy (HR 1.94; 95% CI 1.23-3.07; p=0.004) . In multivariable analysis CHADS2 score was also associated with mortality (HR 1.24; 95% CI 1.17-1.32; p <0.001) as was occurrence of stroke (HR 3.26; 95% CI 2.27-4.67; p <0.001).
Conclusions: In patients with cancer and AF each point increase in CHADS2 is associated with nearly 40% greater risk of stroke and has a stronger association than CHA2DS2-VASc score. Primary cancer site is a unique risk factor in this population. Both CHADS2 score and stroke are associated with worsened survival and oncologists need to address impact of cardiovascular disease on mortality.
Author Disclosures: A. Gutierrez: None. R. Patell: None. L.A. Rybicki: None. A.A. Khorana: None.
- © 2016 by American Heart Association, Inc.