AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
The Bidirectional Association Between Atrial Fibrillation and Cancer, and Relation to Mortality in the Framingham Heart Study
By Stanisic A, Hategeka C, Lau ES et al.
Background: Atrial fibrillation (AF) and cancer are leading causes of morbidity and mortality worldwide, with rising incidence projected over the coming decades. Many risk factors and markers that influence the development of AF and cancer have been studied, but the bidirectional association between these conditions remains unclear. First, we hypothesized that participants with a diagnosis of AF are more likely to be diagnosed with cancer than participants without diagnosed AF. Second, we hypothesized that participants with cancer are more likely to be diagnosed with AF compared to participants without diagnosed cancer. Third, we hypothesized that the presence of AF and cancer are associated with higher all-cause mortality compared to the presence of either condition alone. Methods: We performed a prospective community-based cohort study utilizing the Framingham Heart Study (FHS). We included FHS participants aged ≥45 years who attended study visits between 1970 until 2019. We assessed the hazard ratio (HR) of newly diagnosed AF and cancer, and mortality according to cancer and AF status (prevalent and interim) using multivariable-adjusted Cox proportional hazards models. Models were stratified by cohort and decade, adjusting for age, sex, height, weight, systolic and diastolic blood pressure, antihypertensive treatment, smoking, diabetes, myocardial infarction, and heart failure. Interim diseases were modeled as time-varying variables. Results: The AF analysis included a total of 25,919 person-exams (mean age 60±11 years, 56% women); the cancer analysis included 24,778 person-exams (mean age 60±11 years, 55% women). Interim cancer was associated with higher incident AF (HR 1.66, 95% CI 1.37-2.00) versus those without cancer; prevalent cancer was unassociated with incident AF (HR 0.95, 95% CI 0.81-1.12). Neither prevalent AF (HR 0.89, 95%CI 0.71-1.12) nor interim AF (HR 1.16, 95% CI 0.93-1.45) were associated with incident cancer. Both prevalent cancer (HR 1.70, 95% CI 1.49-1.95) and interim cancer (HR 2.24, 95% CI 1.86-2.70) were associated with higher mortality for participants with newly diagnosed AF (n=1,745). Among participants with newly diagnosed cancer (n=2,417), both prevalent AF (HR 1.53, 95% CI 1.30-1.80) and interim AF (HR 2.41, 95% CI 2.08-2.79) were associated with higher mortality. Conclusions: In a longitudinal community-based cohort, cancer diagnosed during follow-up was significantly associated with increased risk of incident AF, suggesting cancer may act as a risk marker for the development of AF. In contrast, AF was not associated with incidence of cancer. Participants with the diagnoses of both AF and cancer had excess mortality compared to participants with either condition alone regardless of diagnosis order.