Patients with myeloproliferative neoplasms (MPN) are at elevated risk for cardiovascular (CV) disease. Atrial fibrillation (AF) also increases risk for adverse CV events, such as arterial thrombosis, heart failure, and CV death, and coexists with MPN. However, commonly used risk scores for predicting risk/benefit of prophylactic anticoagulant therapy to prevent adverse CV events in patients with atrial fibrillation do not include MPN status.

Therefore, researchers conducted a single-center, retrospective, observational cohort study to gather information on adverse CV outcomes in patients with MPN and atrial fibrillation, and investigate the predictive value of traditional risk scores. Their findings were published in the Journal of Cardiology.

Data were collected from electronic health records at Massachusetts General Hospital. Primary outcomes analyzed were composite outcomes of CV death and nonfatal arterial thromboembotic event; secondary outcomes were bleeding requiring hospitalization or an emergency department visit, hospitalization for heart failure (HF), and all-cause death.


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Multivariable time-to-event analysis showed that among patients with MPN, myelofibrosis is associated with increased risk of CV death, arterial thromboembolism, bleeding, and all-cause mortality  compared with essential thrombocythemia and polycythemia vera, the researchers wrote.

Their findings also suggested that traditional risk projection scores are not enough to accurately predict outcomes for patients with MPN. “Traditional risk stratification scores CHA2DS2-VASC and HAS-BLED, for arterial thrombotic events and bleeding in AF, respectively, may have limitations in predicting events in [patients with MPN],” the researchers wrote.

Although the CHA2DS2-VASC score wasn’t associated with composite outcome or arterial thrombosis in this study, there was an association with an increased risk of heart failure hospitalization and overall rate of arterial thrombosis, which warrants further investigation on refining cardiovascular risk scores in this patient population.

The study’s findings are limited due to its nature as a single-center, retrospective study. Also, patients were selected from only one tertiary referral center, and patients with incomplete information were excluded, which may contribute to selection bias.

“[O]ur small sample size limits our power to detect smaller magnitude of association between CHA2DS2-VASC and HAS-BLED scores and outcomes and thus larger studies are warranted,” concluded the researchers.

Reference

Leiva O, Jenkins A, Rosovsky RP, Leaf RK, Goodarzi K, Hobbs G. Predictors of increased risk of adverse cardiovascular outcomes among patients with myeloproliferative neoplasms and atrial fibrillation. J Cardiol. Published online November 12, 2022. doi:10.1016/j.jjcc.2022.10.007