Predictors of increased risk of adverse cardiovascular outcomes among patients with myeloproliferative neoplasms and atrial fibrillation

Orly Leiva; Andrew Jenkins; Rachel P Rosovsky; Rebecca Karp Leaf; Katayoon Goodarzi; Gabriela Hobbs

doi:10.1016/j.jjcc.2022.10.007

Predictors of increased risk of adverse cardiovascular outcomes among patients with myeloproliferative neoplasms and atrial fibrillation

J Cardiol. 2023 Mar;81(3):260-267. doi: 10.1016/j.jjcc.2022.10.007. Epub 2022 Oct 29.

Authors

Orly Leiva¹, Andrew Jenkins², Rachel P Rosovsky³, Rebecca Karp Leaf³, Katayoon Goodarzi³, Gabriela Hobbs⁴

Affiliations

¹ Division of Cardiovascular Medicine, Department of Medicine, New York University Langone Health, New York, NY, USA; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
² Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
³ Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁴ Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: ghobbs@partners.org.

PMID: 36384716
DOI: 10.1016/j.jjcc.2022.10.007

Abstract

Background: Patients with myeloproliferative neoplasms (MPNs), essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF), have increased risk of cardiovascular (CV) disease. Atrial fibrillation (AF) is associated with adverse CV outcomes including arterial thrombosis, heart failure (HF), and CV death and coexists with MPN. Traditional risk scores (CHA2DS2-VASC and HAS-BLED) for estimating risks/benefits of anticoagulation to prevent thrombotic events in AF do not include MPN status. Therefore, we aimed to investigate CV outcomes in patients with MPN and AF and evaluate the predictive ability of traditional risk scores.

Methods: We conducted a single-center, retrospective cohort study of patients with MPN and AF. Primary outcome was composite of CV death and arterial thromboembolism; secondary outcomes were bleeding requiring emergency department visit or hospitalization, hospitalization for HF, and all-cause death. Multivariable competing-risk and Cox proportional hazards regression models were used to estimate risk of outcomes. Receiver operating characteristic (ROC) curve used to evaluate predictive ability of CHA2DS2-VASC and HAS-BLED of composite outcome and bleeding, respectively.

Results: A total 142 patients was included (62 ET, 54 PV, 26 MF). Composite outcome, bleeding, HF hospitalization and all-cause death occurred in 39 %, 30 %, 34 %, and 48 %, of patients respectively. After multivariable modeling, MF was associated with increased risk of composite outcome (SHR 2.70, 95 % CI 1.38-5.27) and all-cause mortality (HR 9.77, 95 % CI 4.88-19.54) but not bleeding (SHR 1.19, 95 % CI 0.51-2.80) or HF admissions (SHR 0.57, 95 % CI 0.19-1.72). CHA2DS2-VASC and HAS-BLED were poor predictors of composite outcome (C-statistic 0.52, 95 % CI 0.43-0.62) and bleeding (C-statistic 0.49, 95 % CI 0.40-0.58), respectively.

Conclusion: In patients with MPN and AF, MF is associated with increased risk of CV death and arterial thrombosis and traditional risk scores do not accurately predict outcomes in this patient population. Further investigation is needed to refine risk scores in this patient population.

Keywords: Atrial fibrillation; Cardio-oncology; Myelofibrosis; Myeloproliferative neoplasms; Thrombosis.

Published by Elsevier Ltd.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Atrial Fibrillation* / complications
Atrial Fibrillation* / drug therapy
Atrial Fibrillation* / epidemiology
Heart Failure*
Hemorrhage / epidemiology
Humans
Neoplasms* / complications
Retrospective Studies
Risk Assessment
Risk Factors
Stroke* / etiology