Cardio-oncology (London, England) · 2026
Associations between extreme temperatures and hospitalizations among Chinese cancer patients with atrial fibrillation: a case-crossover study.
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Wang Shihao, Wen Yuhang, Shi Shaobo, Yang Xiaolei, Huang Congxin, Huang He, Xia Yunlong
Аннотация
BACKGROUND: Temperature extremes are established triggers of cardiovascular events in the general population, while cancer patients face elevated atrial fibrillation (AF) risk due to disease- and treatment-related factors. However, whether cancer confers additional vulnerability to temperature-related AF events remains unclear. This study aimed to examine the association between extreme temperatures and AF hospitalizations in cancer patients compared with non-cancer controls.
METHODS: Data were derived from the real-world study of the Chinese AF registry (2014-2023), comprising 1,665,014 AF hospitalizations. This study is an exploratory, cancer-focused secondary analysis of the RWS-CAF registry. Overall associations between ambient temperature and AF hospitalization in the full registry have been reported separately. We used a time-stratified case-crossover design with distributed lag nonlinear models to assess temperature-AF associations. Cancer patients (n = 243482) were compared with demographically matched non-cancer controls, and unmatched analyses were performed in the full cohort. Subgroup analyses examined effect modification by age, sex, and geographic region.
RESULTS: Extreme cold (1st percentile, - 5.6 °C) was associated with higher AF hospitalization risk in cancer patients (RR 1.80, 95% CI 1.60-2.03) compared with matched non-cancer controls (RR 1.27, 95% CI 1.21-1.34; Pinteraction < 0.001). The nonoptimal temperature-attributable fraction was also higher in the cancer group (19.7%) than in matched non-cancer patients (10.2%), with cold exposure accounting for the majority of the burden. Among cancer patients, the cold-related RR was higher in males (1.86, 1.62-2.15) than in females (1.37, 1.26-1.50; Pinteraction < 0.001), and the cold-related RR was higher in northern than in southern China (Pinteraction = 0.002). Lag-specific analyses suggested earlier onset and more persistent cold-related risk elevation in the cancer group.
CONCLUSIONS: Patients with cancer appeared more vulnerable to cold-related AF hospitalization than those without cancer, with stronger associations observed in men and in northern regions. These findings support the possibility that cancer modifies the temperature-AF relationship and warrant confirmation in studies with prespecified analyses and more detailed oncologic characterization.
METHODS: Data were derived from the real-world study of the Chinese AF registry (2014-2023), comprising 1,665,014 AF hospitalizations. This study is an exploratory, cancer-focused secondary analysis of the RWS-CAF registry. Overall associations between ambient temperature and AF hospitalization in the full registry have been reported separately. We used a time-stratified case-crossover design with distributed lag nonlinear models to assess temperature-AF associations. Cancer patients (n = 243482) were compared with demographically matched non-cancer controls, and unmatched analyses were performed in the full cohort. Subgroup analyses examined effect modification by age, sex, and geographic region.
RESULTS: Extreme cold (1st percentile, - 5.6 °C) was associated with higher AF hospitalization risk in cancer patients (RR 1.80, 95% CI 1.60-2.03) compared with matched non-cancer controls (RR 1.27, 95% CI 1.21-1.34; Pinteraction < 0.001). The nonoptimal temperature-attributable fraction was also higher in the cancer group (19.7%) than in matched non-cancer patients (10.2%), with cold exposure accounting for the majority of the burden. Among cancer patients, the cold-related RR was higher in males (1.86, 1.62-2.15) than in females (1.37, 1.26-1.50; Pinteraction < 0.001), and the cold-related RR was higher in northern than in southern China (Pinteraction = 0.002). Lag-specific analyses suggested earlier onset and more persistent cold-related risk elevation in the cancer group.
CONCLUSIONS: Patients with cancer appeared more vulnerable to cold-related AF hospitalization than those without cancer, with stronger associations observed in men and in northern regions. These findings support the possibility that cancer modifies the temperature-AF relationship and warrant confirmation in studies with prespecified analyses and more detailed oncologic characterization.