Aims The national incidence, risk factors, and associated mortality of atrial fibrillation (AF) in breast cancer patients are unknown. Methods and results Using the Surveillance, Epidemiology, and End Results-Medicare-linked database, we identified females, ≥66 years old, with a new primary diagnosis of breast cancer from 2007 through 2014. These patients were individually matched 1:1 to Medicare enrolees without cancer, and each pair was followed for 1 year to identify a primary outcome of AF. Cumulative incidence was calculated using competing risk survival statistics. Following this, identifying risk factors of AF among breast cancer patients was conducted using the adjusted Cox proportional hazards model. Finally, Kaplan–Meier methods and adjusted Cox proportional hazards modelling were performed to estimate mortality in breast cancer patients with incident and prevalent AF. This study included 85 423 breast cancer patients. Among these 9425 (11.0%) had AF diagnosis prior to the breast cancer diagnosis. New-onset AF was diagnosed in 2993 (3.9%) patients in a 1-year period after the breast cancer diagnosis [incidence 3.3%, 95% confidence interval (CI) 3.0–3.5%, at 1 year; higher rate in the first 60 days (0.6%/month)]. Comparatively, the incidence of new-onset AF in matched non-cancer controls was 1.8% (95% CI 1.6–2.0%). Apart from traditional demographic and cardiovascular risk factors, breast cancer stage was strongly associated with the development of AF [American Joint Committee on Cancer (AJCC) Stage II/III/IV vs. I: adjusted hazard ratio (aHR) 1.51/2.63/4.21, respectively]. New-onset AF after breast cancer diagnosis (aHR 3.00) is associated with increased 1-year cardiovascular mortality. Conclusion AF incidence is significantly higher in women after a breast cancer diagnosis. Higher breast cancer stages at diagnos are significantly associated with a higher risk of AF. New-onset AF in the new breast cancer diagnosis setting increases 1-year cardiovascular mortality but not breast cancer-related mortality. Key Question What are the incidence, prevalence, risk factors and mortality outcomes of atrial fibrillation (AF) in a multi-ethnic representative United States cohort of breast cancer patients? Key Finding Annual incidence for AF is 3.9% with highest rate in the first 60 days after cancer diagnosis. Cancer stage and grade are the strongest risk factors for AF. New onset AF after breast cancer increases all-cause and cardiovascular mortality. Take Home Message AF incidence is higher in breast cancer patients and is associated with later stage and grade at diagnosis of breast cancer. Involving cardio-oncology in those who develop AF after cancer diagnosis should be encouraged to improve their cardiovascular and overall prognosis.

中文翻译：

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乳腺癌房颤的发病率、危险因素和死亡率：SEER-Medicare 分析


目的 乳腺癌患者心房颤动 (AF) 的全国发病率、危险因素和相关死亡率尚不清楚。方法和结果 利用监测、流行病学和最终结果-医疗保险链接数据库，我们确定了 2007 年至 2014 年新初次诊断为乳腺癌的≥66 岁女性。这些患者与医疗保险按 1:1 单独匹配参与者均未罹患癌症，每对均随访 1 年以确定 AF 的主要结局。使用竞争风险生存统计数据计算累积发生率。此后，使用调整后的 Cox 比例风险模型识别乳腺癌患者 AF 的危险因素。最后，采用 Kaplan-Meier 方法和调整后的 Cox 比例风险模型来估计发生和流行 AF 的乳腺癌患者的死亡率。这项研究包括 85 423 名乳腺癌患者。其中 9425 人 (11.0%) 在乳腺癌诊断之前就已诊断出 AF。乳腺癌诊断后 1 年内，2993 名 (3.9%) 患者被诊断出新发 AF [1 年发生率 3.3%，95% 置信区间 (CI) 3.0–3.5%；前 60 天的比率较高（0.6%/月）]。相比之下，匹配的非癌症对照中新发 AF 的发生率为 1.8%（95% CI 1.6-2.0%）。除了传统的人口统计学和心血管危险因素外，乳腺癌分期与 AF 的发生密切相关 [美国癌症联合委员会 (AJCC) II/III/IV 期与 I 期：调整后风险比 (aHR) 1.51/2.63/4.21 ， 分别]。乳腺癌诊断后新发 AF (aHR 3.00) 与 1 年心血管死亡率增加相关。 结论 女性乳腺癌诊断后 AF 发生率显着升高。诊断时乳腺癌分期越高与房颤风险越高显着相关。在新的乳腺癌诊断背景下，新发房颤会增加 1 年心血管死亡率，但不会增加乳腺癌相关死亡率。关键问题 在美国多种族代表性乳腺癌患者队列中，房颤 (AF) 的发病率、患病率、危险因素和死亡率结果是什么？主要发现 房颤的年发病率为 3.9%，在癌症诊断后的前 60 天内发病率最高。癌症分期和级别是 AF 的最强危险因素。乳腺癌后新发房颤会增加全因死亡率和心血管死亡率。小结 乳腺癌患者的房颤发生率较高，并且与乳腺癌诊断的晚期阶段和分级相关。应鼓励癌症诊断后发生房颤的患者接受心脏肿瘤学治疗，以改善他们的心血管和整体预后。