In recognition that cardiovascular complications can have adverse effect on outcomes for cancer patients, the American Heart Association recently released a new scientific statement to summarize current knowledge and provide guidance on cardiovascular care for patients with cancer and cancer survivors.
The statement was approved by the American Heart Association’s science advisory and coordinating committee on March 11, 2021, and by the AHA’s executive committee on April 22, 2021. It was published in the journal Circulation.
The advent of new cancer treatments has resulted in longer survival times for many cancer patients, but some cancer treatments are associated with cardiovascular toxicities. Arrhythmic complications can develop after a variety of cancer treatments, so strategies are needed to mitigate this risk, the committee stated in their scientific statement.
A number of cancer treatments are associated with atrial fibrillation and other atrial arrhythmias, including anthracycline; melphalan, used in conditioning chemotherapy regimens prior to hematopoietic stem cell transplant [HSCT]; Bruton tyrosine kinase inhibitors; VEGF inhibitors; tyrosine kinase inhibitors targeting BCR-ABL; immune checkpoint inhibitors; and chimeric antigen receptor T-cells. The statement suggests oncology clinicians should follow guidelines created for the general population when managing arrhythmias in patients with cancer, but should take into account the potential for dangerous drug-drug interactions.
The statement authors also summarize the current body of knowledge about anticoagulation and thrombosis prevention, QT prolongation, ventricular arrhythmias, bradyarrhythmias and heart block, and autonomic dysfunction (AD) in patients with cancer. Many aspects of cancer treatment such as psychological stress, weight gain, and sleep disturbance, as well as various types of treatments contribute to autonomic dysfunction, they reported. Some strategies that have been shown to help with AD, as well as others that seem to hold promise and may warrant more evaluation, were also discussed in the statement.
More research is necessary “to understand the underlying mechanisms predisposing patients with cancer to arrhythmias, so that we can develop evidence-based strategies for risk mitigation and management for this unique and vulnerable population,” the statement authors concludes. Collaboration between oncologists and electrophysiologists to create databases that enable more rigorous assessments of arrhythmia-related outcomes in patients with cancer is also recommended by the committee.
Fradley, MG, Beckie TM, Brown SA, et al; American Heart Association Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing. Recognition, prevention, and management of arrhythmias and autonomic disorders in cardio-oncology: a scientific statement from the American Heart Association. Circulation. Published online June 17, 2021. doi:10.1161/CIR.0000000000000986