Mid- and long-term risk of atrial fibrillation among breast cancer surgery survivors

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Abstract

Background

The risk of incident atrial fibrillation (AF) among breast cancer survivors, especially for younger women, and cancer treatment effects on the association remain unclear. This study aimed to investigate the risk of AF among breast cancer survivors and evaluate the association by age group, length of follow-up, and cancer treatment.

Methods

Using data from the Korean Health Insurance Service database (2010–2017), 113,232 women newly diagnosed with breast cancer (aged ≥ 18 years) without prior AF history who underwent breast cancer surgery were individually matched 1:5 by birth year to a sample female population without cancer ( n = 566,160) (mean[SD] follow-up, 5.1[2.1] years). Sub-distribution hazard ratios (sHRs) and 95% confidence intervals (CIs) considering death as a competing risk were estimated, adjusting for sociodemographic factors and cardiovascular/non-cardiovascular comorbidities.

Results

BCS had a slightly increased AF risk compared to their cancer-free counterparts (sHR 1.06; 95% CI 1.00–1.13), but the association disappeared over time. Younger BCS (age < 40 years) had more than a 2-fold increase in AF risk (sHR 2.79; 95% CI 1.98–3.94), with the association remaining similar over 5 years of follow-up. The increased risk was not observed among older BCS, especially those aged > 65 years. Use of anthracyclines was associated with increased AF risk among BCS (sHR 1.57; 95% CI 1.28–1.92), which was more robust in younger BCS (sHR 1.94; 95% CI 1.40–2.69 in those aged ≤ 50 years).

Conclusions

Our findings suggest that younger BCS had an elevated risk of incident AF, regardless of the length of follow-up. Use of anthracyclines may be associated with increased mid-to-long-term AF risk among BCS.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s12916-024-03308-z.

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Most cited references 43

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A Proportional Hazards Model for the Subdistribution of a Competing Risk

Jason P. Fine, Robert J Gray (1999)

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Cancer treatment and survivorship statistics, 2019

Kimberly D Miller, Leticia Nogueira, Angela Mariotto … (2019)

The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types. Cancer-related and treatment-related short-term, long-term, and late health effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.

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Is Open Access

Data Resource Profile: The National Health Information Database of the National Health Insurance Service in South Korea

Sang Cheol Seong, Yeon-Yong Kim, Young-Ho Khang … (2016)

Data resource basics The National Health Information Database (NHID) is a public database on health care utilization, health screening, socio-demographic variables, and mortality for the whole population of South Korea, formed by the National Health Insurance Service. The population included in the data is over 50 million, and the participation rate in the health screening programs was 74.8% in 2014. The NHID covers data between 2002 and 2014. Those insured by NHI pay insurance contributions and receive medical services from their health care providers. The NHIS, as the single insurer, pays costs based on the billing records of health care providers (Figure 1). To govern and carry out these processes in the NHI, the NHIS built a data warehouse to collect the required information on insurance eligibility, insurance contributions, medical history, and medical institutions. In 2012, the NHIS formed the NHID using information from medical treatment and health screening records and eligibility data from an existing database system. Figure 1. The governance of the National Health Insurance of South Korea. Data collected The eligibility database includes information about income-based insurance contributions, demographic variables, and date of death. The national health screening database includes information on health behaviors and bio-clinical variables. The health care utilization database includes information on records on inpatient and outpatient usage (diagnosis, length of stay, treatment costs, services received) and prescription records (drug code, days prescribed, daily dosage). The long-term care insurance database includes information about activities of daily living and service grades. The health care provider database includes data about the types of institutions, human resources, and equipment. In the NHID, de-identified join keys replacing the personal identifiers are used to interlink these databases. Data resource use Papers published covered various diseases or health conditions like infectious diseases, cancer, cardiovascular diseases, hypertension, diabetes mellitus, and injuries and risk factors such as smoking, alcohol consumption, and obesity. The impacts of health care and public health policies on health care utilization have been also explored since the data include all the necessary information reflecting patterns of health care utilization. Reasons to be cautious First, information on diagnosis and disease may not be optimal for identifying disease occurrence and prevalence since the data have been collected for medical service claims and reimbursement. However, the NHID also collects prescription data with secondary diagnosis, so the accuracy of the disease information can be improved. Second, the data linkage with other secondary national data is not widely available due to privacy issues in Korea. Governmental discussions on the statutory reform of data linkage using the NHID are under way. Collaboration and data access Access to the NHID can be obtained through the Health Insurance Data Service home page (http://nhiss.nhis.or.kr). An ethics approval from the researchers’ institutional review board is required with submission of a study proposal, which is reviewed by the NHIS review committee before providing data. Further inquiries on data use can be obtained by contacting the corresponding author. Funding and competing interests This work was supported by the NHIS in South Korea. The authors declare no competing interests.

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Author and article information

Contributors

Kyungdo Han:

ORCID: https://orcid.org/0000-0002-6096-1263

hkd917@naver.com

Dong Wook Shin: dwshin.md@gmail.com

Journal

Journal ID (nlm-ta): BMC Med

Journal ID (iso-abbrev): BMC Med

Title: BMC Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1741-7015

Publication date (Electronic): 28 February 2024

Publication date PMC-release: 28 February 2024

Publication date Collection: 2024

Volume: 22

Electronic Location Identifier: 88

Affiliations

[1 ]Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, ( https://ror.org/00xcryt71) Little Rock, AR USA

[2 ]Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, ( https://ror.org/00xcryt71) Little Rock, AR USA

[3 ]Department of Family Medicine / Obesity and Metabolic Health Center, College of Medicine, Hallym University Kangdong Sacred Heart Hospital, ( https://ror.org/05mx1gf76) Seoul, Republic of Korea

[4 ]Department of Medicine, Sungkyunkwan University School of Medicine, ( https://ror.org/04q78tk20) Seoul, Republic of Korea

[5 ]Department of Family Medicine, College of Medicine, Hallym University Dongtan Sacred Heart Hospital, ( https://ror.org/04n278m24) Hwaseong, Republic of Korea

[6 ]Department of Biostatistics, College of Medicine, The Catholic University of Korea, ( https://ror.org/01fpnj063) Seoul, Republic of Korea

[7 ]Cardio-Oncology Program, Division of Cardiology, Department of Internal Medicine, University of Pennsylvania, ( https://ror.org/00b30xv10) Philadelphia, PA USA

[8 ]Division of Medical Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, ( https://ror.org/00xcryt71) Little Rock, AR USA

[9 ]Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, ( https://ror.org/00xcryt71) Little Rock, AR USA

[10 ]Department of Biology & Department of Math and Computer Science, University of Arkansas at Pine Bluff, ( https://ror.org/03zsjhd07) Pine Bluff, AR USA

[11 ]Division of Cardiology, Sarver Heart Center, Banner University Medical Group, University of Arizona, ( https://ror.org/03m2x1q45) Tucson, AZ USA

[12 ]Division of Echocardiography, Department of Cardiovascular Medicine, Mayo Clinic, ( https://ror.org/02qp3tb03) Phoenix, AZ USA

[13 ]Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, ( https://ror.org/00xcryt71) Little Rock, AR USA

[14 ]Department of Medicine, College of Medicine, University of Arkansas for Medical Sciences, ( https://ror.org/00xcryt71) Little Rock, AR USA

[15 ]Department of Statistics and Actuarial Science, Soongsil University, ( https://ror.org/017xnm587) 369 Sangdo-Ro, Dongjak-Gu, Seoul, 06978 Republic of Korea

[16 ]GRID grid.264381.a, ISNI 0000 0001 2181 989X, Department of Family Medicine and Supportive Care Center, Samsung Medical Center, , Sungkyunkwan University School of Medicine, ; 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351 Republic of Korea

[17 ]Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, ( https://ror.org/04q78tk20) Seoul, 06351 Republic of Korea

Author information

Kyungdo Han https://orcid.org/0000-0002-6096-1263

Article

Publisher ID: 3308

DOI: 10.1186/s12916-024-03308-z

PMC ID: 10903065

PubMed ID: 38419017

SO-VID: 6202201f-dcfc-42cc-a804-90c2fe5900b9

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 19 September 2023

Date accepted : 19 February 2024

Funding

Funded by: the Arkansas Breast Cancer Research Program

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ScienceOpen disciplines: Medicine

Keywords: atrial fibrillation,breast cancer,anthracyclines,younger breast cancer survivors

Data availability:

ScienceOpen disciplines: Medicine

Keywords: atrial fibrillation, breast cancer, anthracyclines, younger breast cancer survivors

Mid- and long-term risk of atrial fibrillation among breast cancer surgery survivors

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Abstract

Background

Methods

Results

Conclusions

Graphical Abstract

Supplementary Information

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Karger: Cardiovascular System

Most cited references 43

A Proportional Hazards Model for the Subdistribution of a Competing Risk

Cancer treatment and survivorship statistics, 2019

Data Resource Profile: The National Health Information Database of the National Health Insurance Service in South Korea

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