# Atrial Fibrillation Risk in Relation to the Clinical Staging of Gastric Cancer: A Nationwide Population-Based Cohort Study

## TL;DR

This study shows that the risk of atrial fibrillation increases with the stage of gastric cancer, even in patients without traditional heart risk factors.

## Contribution

The study reveals a progressive increase in atrial fibrillation risk with advancing gastric cancer stages using nationwide population data.

## Key findings

- Atrial fibrillation risk increases progressively with gastric cancer stage, with distant stage showing the highest risk.
- Subgroup analyses showed stronger associations in younger, female, and non-hypertensive patients.
- Patients with advanced-stage gastric cancer require closer monitoring for atrial fibrillation to improve survival.

## Abstract

While the elevated risk of atrial fibrillation (AF) in patients diagnosed with cancer is well established, the effect of cancer stage on the risk of AF is unclear. A nationwide cohort study in Korea revealed a progressive increase in AF risk according to the clinical stage of gastric cancer, especially in those without conventional risk factors for AF. This highlights the need for closer monitoring and management of AF to improve the survival of patients with advanced-stage gastric cancer.

Background/Objectives: Patients with gastric cancer (GC) have an elevated risk of atrial fibrillation (AF) and cardiovascular mortality, compared with the general population. However, the effect of the cancer stage on the development of AF remains unclear. This study aimed to evaluate the relationship between the risk of AF and GC stage based on the Surveillance, Epidemiology, and End Results (SEER) stage classifications. Methods: This retrospective population-based cohort study enrolled patients diagnosed with GC between 2012 and 2019, using anonymized data from the Cancer Public Library Database of South Korea. Patients were followed up until 2020. The risk of AF was assessed in relation to the SEER stage of GC (localized, regional, distant) using adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). Subgroup analyses were performed according to age, sex, year of diagnosis, and comorbidities. Results: Of the 211,500 patients enrolled in this study, 7266 were diagnosed with AF during follow-up. The risk of AF increased progressively with cancer stage, with aHRs of 2.00 (95% CI 1.81–2.22) for the distant stage and 1.32 (95% 1.25–1.41) for the regional stage, compared with the localized stage. Subgroup analyses showed a consistent association between advanced cancer stage and a higher AF risk; the association was stronger in the younger, female, and non-hypertensive subgroups. Conclusions: The risk of AF in patients with GC is associated with the initial stage, highlighting the need for the closer monitoring and management of AF to improve the survival of patients with advanced-stage GC.