AFib Patients Who Had Cancer Are Less Likely to Fill Their Anticoagulant Prescriptions

Atrial fibrillation (AFib) patients with a history of cancer are less likely to see a cardiologist or fill anticoagulant prescriptions, compared to AFib patients who had never had cancer, a recent study notes. But those who are treated by a cardiologist are more likely to stick with their anticoagulant regimens

These patients are potentially putting themselves at increased risk of stroke by not filling and taking prescribed medication, according to the study, published in the October issue of Journal of the American College of Cardiology.

Researchers at Emory University School of Medicine examined the relationship between early cardiology involvement after an AFib diagnosis in patients with a history of cancer and how that affected outcomes. After reviewing records of more than 64,000 AFib patients with a history of cancer, they found that cancer patients were less likely to see a cardiologist after AFib diagnosis and less likely to fill prescriptions for oral anticoagulants.

Prostate and breast cancers were the most common types of cancer in the reviewed records. The study found that patients with a history of cancer were also older and more likely to have other cardiovascular conditions, according to a statement from the American College of Cardiology (ACC).

However, after about a year of followup, cancer patients who visited a cardiologist were more likely to fill their prescriptions, showed a reduced risk of stroke, and did not show an increased risk of bleeding, the study found. These patients were also more likely to be hospitalized, which may be due to more aggressive treatments, ACC states.

“Although AF patients with cancer were less likely to see a cardiologist, or fill anticoagulant prescriptions, cardiology involvement was associated with increased anticoagulant prescription fills and favorable AF-related outcomes in AF patients with cancer,” writes Wesley T. O'Neal, MD, lead author of the study and a cardiology fellow at Emory University School of Medicine in Atlanta, in the study.

"Overall, our data suggest that suboptimal antithrombotic care exists in AFib patients who have a history of cancer. The decision to initiate antithrombotic therapy or refer to a cardiology provider should be individualized to the patient, but our data suggest that cardiology providers positively influence outcomes among these patients,” adds O’Neal in the statement.

According to a related editorial published in the same issue of the Journal of the American College of Cardiology, the number of cancer survivors in the United States is expected to rise from more than 15 million currently to more than 20 million by 2026, which could lead to an increased focus on addressing their other long-term medical and psychosocial needs.

"The management of cancer patients must extend beyond their primary malignancy and will require an interdisciplinary approach from oncologists, primary care providers and other subspecialists," said Sean T. Chen, MD, an author of the editorial and an internal medicine resident at Duke University Medical Center.

The research was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health, the National Institute on Aging of the NIH, and the American Heart Association.