Atrial Fibrillation Is Associated with Increased In-Hospitality Mortality During Chimeric Antigen Receptor T-cell Therapy Hospitalizations: A Retrospective Cohort Study in the United States.
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Background: Chimeric Antigen Receptor (CAR) T-cell therapy (CAR-T) has emerged as a promising treatment for specific hematological malignancies. While some studies suggest an association between CAR-T and atrial fibrillation (AF), more data are needed on the impact of AF on CAR-T outcomes. Methods: This retrospective cohort study utilized the National Inpatient Sample (NIS) 2017-2020 to explore in-hospital outcomes in cancer patients with AF while undergoing CAR-T. Comparisons were drawn between patients with and without AF (occurring at any time), assessing various parameters including mortality rates, length of hospital-stay, and occurrences of acute heart failure, pulmonary edema, and gastrointestinal (GI) bleeding. Results: Of the 236,270 cancer-related hospitalizations, 1,030 cases (0.44%) received CAR-T. The average age of CAR-T recipients was 55.6 years ±18.1 years, and females constituted 40.5% of the total CAR-T recipients. Of the 1030 patients receiving CAR-T, 97 (9.4%) had an associated diagnosis of AF (occurring at any time) during their hospitalization. A multivariable logistic regression analysis, adjusted for age, sex, race, comorbidity, and income, revealed that cancer hospitalizations who underwent CAR-T therapy with AF had increased odds of in-hospital mortality (adjusted odds ratio, aOR: 3.87), acute pulmonary edema (aOR: 3.29), GI bleeding (aOR: 5.46), acute heart failure (aOR: 10.2), and extended hospital stays (Beta coefficient: 0.18) compared to hospitalizations with CAR-T but without AF. Similar results were seen in a sensitivity analysis limited to diffuse large B cell lymphoma patients receiving CAR-T. Conclusions: In cancer patients receiving CAR-T, AF is independently associated with a higher risk of in-hospital mortality, acute pulmonary edema, gastrointestinal bleeding, acute heart failure, and prolonged hospitalization.
