Background: Atrial fibrillation (AF) is one of the most common heart arrhythmias world-wide with Americans >40 years old having a lifetime risk of 26% for men and 23% for women. It is estimated that 2.3 million adults in the United States are currently diagnosed with AF with an expected increase to 5.6 million by the year 2050. AF is strongly associated with significant cardiovascular (CV) and cerebrovascular compilations such as heart failure, stroke and myocardial infarction, as well as non-CV causes of death including cancer. Previous investigative focus has been on incidence of AF post-cancer diagnosis or as sequela following cancer treatment. This systematic review is aimed at assessing the incidence of AF prior to cancer diagnosis and potential utilization in preventative cancer screening.
Methods: An exhaustive search of current literature was performed using MEDLINE-Ovid, CINAHL and Web of Science. Keywords used included: atrial fibrillation, neoplasms and risk. Bibliographies of resulting articles were referenced for additional relevant studies. Articles selected for review were published in the English language, were exclusive to human subjects and investigated AF preceding cancer diagnosis. Articles were assessed for quality using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
Results: The literature search yielded a total of 202 studies; two observational cohort studies met the designated criteria for this systematic review. Both observational studies demonstrated a correlation between new onset AF and subsequent cancer diagnosis.
Conclusion: Two observational studies revealed a correlation between new onset AF and cancer diagnosis, specifically colorectal and lung cancers. The quality of evidence is moderate given the high likelihood of detection bias; additionally these studies could not be directly compared due to the different populations included in the research. There is also the question of what to do with this information as cancer screening often involves expensive and invasive procedures. Given that AF is one of the most common arrhythmias worldwide, it would be unreasonable to subject such a vast number of individuals to these unnecessary screenings. However, it is reasonable to expect future studies to investigate this correlation in a large diverse population in effort to assess a more accurate level of cancer risk in those who are newly diagnosed with AF.
Keywords: Atrial fibrillation, cancer, neoplasms, and risk
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