Cardiac arrhythmias and conduction disorders after breast cancer treatment including radiotherapy: a study based on the French nationwide health database

International audienceIntroduction: We plan to evaluate whether breast cancer (BC) treatment, including radiotherapy, is associated with an increased risk of cardiac arrhythmias and conduction disorders (ACD) characterized by implantation of pacemaker or defibrillator or hospitalization for rhythm disorders.Methods: Our study is based on the Echantillon Généraliste de Bénéficiaires (EGB), the 1/97 random sample of the French nationwide health database. We identify patients treated for BC between 2008 and 2012 and cases of ACD arising post BC until 2017. The ACD incidence rates according to BC treatment (Surgery±Chemotherapy±Radiotherapy) will be estimated and compared to the national incidence rates estimated from the EGB population.Results: Within an initial cohort of approximately 260 000 women in the EGB, nearly 3000 patients treated for BC. We should detect ~5000 incident cases of ACD in the EGB cohort. The observation of at least 85 incident cases of ACD in the BC subgroup instead of 60 (RR=1.4) will have a statistical power of 80%.Conclusion: The study is ongoing. It will allow quantifying the excess risk of ACD suspected for BC treatment, in particular mediastinal radiotherapy

Risque d'implantation de stimulateur cardiaque après traitement pour un cancer du sein: étude à partir des données médico-administratives de l’assurance maladie

International audienceIntroduction et but de l’étude: Les traitements médicaux anticancéreux et à la radiothérapie pour le cancer du seinpeuvent entrainer certaines formes de cardiotoxicité et de complication cardiaques, mais les connaissances sur lestroubles de la conduction cardiaques restent limitées. Cette étude vise à examiner le risque d'implantation de stimulateurcardiaque (pacemaker - PM) après traitement pour un cancer du sein en comparant l'incidence des PM chez lespatientes traitées pour un cancer du sein par rapport à celle de la population générale d’âge comparable.Matériel et méthodes: Notre étude s’est basée sur l'Echantillon Généraliste de Bénéficiaires (EGB), l'échantillonaléatoire au 1/97e de la base de données nationale de l’assurance maladie (SNDS). La population étudiée étaitconstituée de femmes adultes traitées pour un primo cancer du sein entre 2008 et 2014, sans antécédent d'implantationde PM et suivies jusqu'en 2016. Pour chaque année de 2008 à 2016, la population de référence annuelle comprenaittoutes les femmes présentes dans l'EGB sans antécédents de PM ou de cancer du sein. Dans les deux populations, lesimplantations de PM ont été identifiées avec les codes correspondants dans la classification commune de des actesmédicaux (CCAM). Le ratio d’incidence standardisé (SIR) a été calculé par le rapport du nombre de PM observés dans lapopulation cancer du sein sur le nombre de PM attendus dans cette population calculé à l'aide des taux d'incidenceannuels des PM selon l'âge de la population de référence, pondérés en fonction de la structure d’âge de la populationcancer du sein.Résultats et analyse statistique: Entre 2008 et 2016, la population de référence annuelle était composée de près de 193000 femmes avec un taux d'incidence d'implantation de PM variant de 1/100 000 dans la catégorie plus jeune ( 60 ans) chez qui 18 implantations de PM ont été observées par rapport à 11,5 attendues, donnantun SIR de 1,56 (IC à 95% de 0,93 à 2,36) indiquant une incidence d’implantation de PM 56% plus élevée dans lapopulation des femmes traitées pour un cancer du sein.Conclusion: Ces résultats préliminaires indiquent que le traitement du cancer du sein pourrait être associé à un risqueaccru d'implantation de PM. Une analyse plus approfondie selon le type de traitement (radiothérapie, chimiothérapie…)est en cours

Cardiac arrhythmias and conduction disorders after breast cancer treatment including radiotherapy: a study based on the French nationwide health database

International audienceIntroduction: We plan to evaluate whether breast cancer (BC) treatment, including radiotherapy, is associated with an increased risk of cardiac arrhythmias and conduction disorders (ACD) characterized by implantation of pacemaker or defibrillator or hospitalization for rhythm disorders.Methods: Our study is based on the Echantillon Généraliste de Bénéficiaires (EGB), the 1/97 random sample of the French nationwide health database. We identify patients treated for BC between 2008 and 2012 and cases of ACD arising post BC until 2017. The ACD incidence rates according to BC treatment (Surgery±Chemotherapy±Radiotherapy) will be estimated and compared to the national incidence rates estimated from the EGB population.Results: Within an initial cohort of approximately 260 000 women in the EGB, nearly 3000 patients treated for BC. We should detect ~5000 incident cases of ACD in the EGB cohort. The observation of at least 85 incident cases of ACD in the BC subgroup instead of 60 (RR=1.4) will have a statistical power of 80%.Conclusion: The study is ongoing. It will allow quantifying the excess risk of ACD suspected for BC treatment, in particular mediastinal radiotherapy

Cardiac arrhythmias and conduction disorders after breast cancer treatment including radiotherapy: a study based on the French nationwide health database

International audienceIntroduction: We plan to evaluate whether breast cancer (BC) treatment, including radiotherapy, is associated with an increased risk of cardiac arrhythmias and conduction disorders (ACD) characterized by implantation of pacemaker or defibrillator or hospitalization for rhythm disorders.Methods: Our study is based on the Echantillon Généraliste de Bénéficiaires (EGB), the 1/97 random sample of the French nationwide health database. We identify patients treated for BC between 2008 and 2012 and cases of ACD arising post BC until 2017. The ACD incidence rates according to BC treatment (Surgery±Chemotherapy±Radiotherapy) will be estimated and compared to the national incidence rates estimated from the EGB population.Results: Within an initial cohort of approximately 260 000 women in the EGB, nearly 3000 patients treated for BC. We should detect ~5000 incident cases of ACD in the EGB cohort. The observation of at least 85 incident cases of ACD in the BC subgroup instead of 60 (RR=1.4) will have a statistical power of 80%.Conclusion: The study is ongoing. It will allow quantifying the excess risk of ACD suspected for BC treatment, in particular mediastinal radiotherapy

Relation of outcomes to ABC (Atrial Fibrillation Better Care) pathway adherent care in European patients with atrial fibrillation: an analysis from the ESC-EHRA EORP Atrial Fibrillation General Long-Term (AFGen LT) Registry

International audienceAbstract Aims There has been an increasing focus on integrated, multidisciplinary, and holistic care in the treatment of atrial fibrillation (AF). The ‘Atrial Fibrillation Better Care’ (ABC) pathway has been proposed to streamline integrated care in AF. We evaluated the impact on outcomes of an ABC adherent management in a contemporary real-life European-wide AF cohort. Methods and results Patients enrolled in the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry with baseline data to evaluate ABC criteria and available follow-up data were considered for this analysis. Among the original 11 096 AF patients enrolled, 6646 (59.9%) were included in this analysis, of which 1996 (30.0%) managed as ABC adherent. Patients adherent to ABC care had lower CHA2DS2-VASc and HAS-BLED scores (mean ± SD, 2.68 ± 1.57 vs. 3.07 ± 1.90 and 1.26 ± 0.93 vs. 1.58 ± 1.12, respectively; P < 0.001). At 1-year follow-up, patients managed adherent to ABC pathway compared to non-adherent ones had a lower rate of any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death (3.8% vs. 7.6%), CV death (1.9% vs. 4.8%), and all-cause death (3.0% vs. 6.4%) (all P < 0.0001). On Cox multivariable regression analysis, ABC adherent care showed an association with a lower risk of any TE/ACS/CV death [hazard ratio (HR): 0.59, 95% confidence interval (CI): 0.44–0.79], CV death (HR: 0.52, 95% CI: 0.35–0.78), and all-cause death (HR: 0.57, 95% CI: 0.43–0.78). Conclusion In a large contemporary cohort of European AF patients, a clinical management adherent to ABC pathway for integrated care is associated with a significant lower risk for cardiovascular events, CV death, and all-cause death