Atrial Fibrillation in Breast Cancer Patients: Incidence, Prevalence, Risk Factors and Mortality: Longitudinal SEER-Medicare Analysis Open Access

Guha, Avirup (Summer 2021)

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Background: The national incidence, risk factor, and associated mortality of atrial fibrillation (AF) in breast cancer patients are unknown.

Methods: Using the Surveillance, Epidemiology, and End Results–Medicare linked database, we identified females, ≥ 66-year-old, with a new primary diagnosis of breast cancer from 2007 through 2014. These patients were individually matched 1:1 to Medicare enrollees without cancer, and each pair was followed for one year to identify a primary outcome of AF. Cumulative incidence rates were calculated using competing risk survival statistics. Following this, risk factor analysis was conducted using the adjusted Cox proportional hazards model. Finally, Kaplan-Meier methods and adjusted Cox proportional hazards modeling were performed to estimate mortality in breast cancer patients with the incident and prevalent AF.

Results: This study included 85,423 breast cancer patients. Among these 9,425 (11.0%) had AF diagnosis prior to the breast cancer diagnosis. New AF was diagnosed in 2,993 (3.9%) patients in a 1-year period after the breast cancer diagnosis (incidence rate = 3.3% (95% CI = 3.0% - 3.5%) at 1-year; higher rate in the first 60 days (0.6%/month)]. The population standardized AF incidence was higher in black compared to white females (58.8 vs. 49.9 per 1000 person-years in 2014, respectively). Apart from traditional demographic and cardiovascular risk factors, breast cancer stage was strongly associated with development of AF [AJCC Stage 2 vs. 1: adjusted HR (aHR)= 1.51 (95% CI= 1.37 – 1.65); AJCC Stage 3 vs. 1: aHR= 2.63 (95% CI= 2.35 – 2.94); AJCC Stage 4 vs. 1: aHR= 4.21 (95% CI= 4.04 – 5.48)]. New onset AF after breast cancer diagnosis (aHR = 3.51 [95% CI = 1.69 – 7.32]) and prevalent AF prior to breast cancer diagnosis (aHR = 1.70 [95% CI = 1.26 – 2.29]) was associated with increased 1-year- cardiovascular mortality.

Conclusion: AF incidence is significantly higher in women after a breast cancer diagnosis, particularly in black women. Apart from traditional risk factors, higher breast cancer stages at diagnosis are significantly associated with a higher risk of AF. New or prevalent AF in the setting of new breast cancer increases 1-year cardiovascular mortality but not breast cancer-related mortality.

Table of Contents

Chapter Page Number

Chapter 1 Literature Review

Full literature review 1

Statement of problem 4

Purpose of thesis 4

Chapter 2 Journal Article

Introduction 6

Methods: Data Source 7

Methods: Study Population 7

Methods: Data Extraction and Definitions 8

Methods: Outcomes 9

Methods: Statistics 10

Results: Demographics 12

Results: Incidence 12

Results: Risk Factors for AF 13

Results: Mortality 14

Discussion 15

Limitations 17

Conclusion 18

Chapter 3

Conclusions 20

Future Directions 20

Public health implications 20

References 22

Tables 30

Figures 36

Supplemental 40

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