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    Determinants of Atrial Fibrillation Development among Patients undergoing Ibrutinib Therapy

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    16.full.pdf (622.4Kb)
    Date
    2022-03-01
    Author
    Onitilo, Adedayo A.
    Piwuna, Tinuade O.
    Islam, Nazmul
    Furuya-Kanamori, Luis
    Kumar, Sanjay
    Doi, Suhail A.R.
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    Abstract
    Objective: Within the last decade, the use of ibrutinib, a first-generation, non-selective, irreversible Burton's tyrosine kinase inhibitor for the treatment of hematological malignancies has proven highly effective in improving patient outcomes.Background: Ibrutinib has been associated with an increase in atrial fibrillation (AF). The predisposing factors are thought to be pre-existing cardiovascular risk factors, but these have not been directly evaluated.Methods: We conducted a nested case-control study, recruiting consecutive ibrutinib treated subjects to evaluate cardiovascular risk factors associated with the development of AF in patients diagnosed with hematological B-cell malignancies.Results: Of the 189 patients treated with ibrutinib and without AF at baseline, 54 (29%) developed AF. Cardiovascular risk factors associated with AF development were, older age, prior hypertension (HTN), history of heart failure (HF) and congenital heart disease. A patient with HF at baseline had a 1,2, 6, and 12 month cumulative hazard of AF of 40%, 48%, 64%, and 71%, respectively. Patients with prior HTN without HF at baseline had a 1,2, 6, and 12 month cumulative hazard of AF of 5%, 10%, 23%, and 31%, respectively while on ibrutinib therapy.Conclusions: The relationship between ibrutinib, cardiovascular comorbidities, and AF is through pre-existing cardiovascular disease. An individualized, multidisciplinary approach involving cardiologists should be considered when initiating ibrutinib, particularly when there is a history of HTN, HF or congenital heart disease. In such patients, there should be close cardiovascular monitoring and prompt intervention when AF develops to improve patient outcomes.
    URI
    https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85128489433&origin=inward
    DOI/handle
    http://dx.doi.org/10.3121/cmr.2021.1693
    http://hdl.handle.net/10576/40262
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    • Medicine Research [‎1762‎ items ]
    • Public Health [‎486‎ items ]

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