Association between cancer, CHA2DS2VASc risk and In-hospital ischemic stroke in patients hospitalized for atrial fibrillation.

Matetic A, Mohamed MO, Essien UR, Guha A, Elkaryoni A, Elbadawi A, Van Spall HGC, Mamas MA. Association between cancer, CHA2DS2VASc risk and In-hospital ischemic stroke in patients hospitalized for atrial fibrillation. European heart journal. Quality of care & clinical outcomes. 2023 Jan 3.

Related HSR&D Project(s)

• CDA 20-049 – Access, Quality and Equity of Anticoagulants in Veterans with Atrial Fibrillation

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Abstract:

BACKGROUND: Atrial fibrillation (AF) is commonly encountered in cancer patients. We investigated the CHA2DS2VASc score, and its association with in-hospital ischemic stroke in patients with cancer who were hospitalized for AF. METHODS AND RESULTS: Using the United States National Inpatient Sample, all hospitalizations with principal diagnosis of AF between October 2015 to December 2018 were stratified by cancer diagnosis, type and CHA2DS2VASc risk categories (low risk; low-moderate risk; moderate-high risk). In-hospital ischemic stroke and its association with the CHA2DS2VASc risk score was assessed across the groups using hierarchical multivariable logistic regression with adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Discrimination of CHA2DS2VASc score for in-hospital ischemic stroke was evaluated with Receiver Operating Characteristic and Area Under the Curve (AUC). Among 1 341 870 included hospitalizations, 71 965 (5.4%) had comorbid cancer. Cancer patients had a higher proportion of moderate-high CHA2DS2VASc risk compared to their non-cancer counterparts (86.5% vs. 82.3%, p  <  0.001). Compared to their low CHA2DS2VASc risk counterparts, cancer patients in low-moderate and moderate-high risk scores had similar odds of developing stroke (aOR 1.28 95% CI 0.22-7.63 and aOR 1.78 95% CI 0.41-7.66, respectively). The CHA2DS2VASc risk score had poor discrimination for ischemic stroke in the cancer group (AUC 0.538 95% CI 0.477-0.598). CONCLUSION: Cancer patients with AF have high CHA2DS2VASc risk. Discrimination of CHA2DS2VASc for ischemic stroke is lower in cancer than non-cancer patients, and CHA2DS2VASc may not be adequate in determining ischemic risk in cancer population.