The objective of the study was to evaluate the impact of atrial fibrillation (AF) on cardiovascular outcomes and healthcare resource utilization in adults newly diagnosed with chronic lymphocytic leukemia (CLL).

This retrospective observational study used data from the Symphony database to identify adults newly diagnosed with CLL between 2014 and 2024. Patients were followed for one year after diagnosis to assess the incidence of AF. Subsequent cardiovascular outcomes, including stroke, bleeding, and heart failure, as well as healthcare resource utilization (inpatient, outpatient, and other services), were compared between patients with and without AF. Multivariable regression analyses were conducted to assess associations between AF and these outcomes. Exploratory analyses evaluated outcomes by first‑line Bruton tyrosine kinase inhibitor therapy, including ibrutinib, acalabrutinib, and zanubrutinib.

Among 233,362 newly diagnosed patients with CLL, 13.1% had AF within 1 year of diagnosis. Patients with AF had a higher likelihood of at least one inpatient visit compared with those without AF (54.9% vs 23.2%; P<0.0001) and were more likely to incur inpatient services (odds ratio [OR], 2.28; 95% CI, 2.21–2.35). Higher proportions of patients with AF experienced subsequent stroke (14.3% vs 8.9%), bleeding (27.9% vs 19.1%), and heart failure (54.5% vs 18.9%) than those without AF (all P<0.0001). Age ≥65 years, male sex, non‑White race, and AF were associated with these outcomes (P<0.01).

 
Among patients initiating first–line BTKis, AF within one year occurred in 11% with zanubrutinib, 13% with acalabrutinib, and 16% with ibrutinib (P<0.0001). Compared to first-line ibrutinib and first-line acalabrutinib, a lower proportion of patients with AF treated with first–line zanubrutinib had subsequent stroke (12.2% vs 9.4% vs 4.8%, respectively; P<0.002), bleeding (27.4% vs 21.5% vs 17.4%; P<0.002), heart failure (50.9% vs 45.6% vs 39.6%; P<0.002), and inpatient service use (46.4% vs 51.5% vs 60.4%; P<0.0001).