ACC Learning Portal

Managing AFib and BTK Inhibitors: Balancing Risk

As evidence on the association between cancer and atrial fibrillation (AF) continues to grow, an understanding of the impact on cancer and AF epidemiology and presentation will be essential to improving the cardio-oncologic care of patients with cancer. To educate the medical community about the importance of assessing risk, monitoring, and managing AF and other cardiovascular risk factors for cancer patients, the ACC has created the Managing AFib and BTK Inhibitors: Balancing Risk initiative. This initiative will focus on treatment for chronic lymphocytic leukemia/lymphoma (CLL), which is associated with a higher incidence of atrial fibrillation, as a case study for balancing risk in AF and cancer management. Stay up to date on best practices to guide clinical decision making and improve management of patients with AF and cancer.

	Interactive Infographic: Anticoagulation for Atrial Fibrillation (AFib) in Patients Receiving Bruton Tyrosine Kinase (BTK) Inhibitors I June 1, 2021 This Interactive Infographic covers important topics such as patient-specific risk factors, antiplatelet activity of BTK inhibitors and drug-drug interactions, as well as the steps to anticoagulation and dosing requirements in different CLL patients.
	Patient Case Quiz \| Cardiovascular Adverse Effects of Bruton's Tyrosine Kinase (BTK) Inhibitors I February 18, 2021 A 66-year-old woman with Waldenstrom macroglobulinemia presents with progressive splenomegaly and fatigue.
	Patient Case Quiz \| Management of Atrial Fibrillation in Patients Treated with Bruton's Tyrosine Kinase (BTK) Inhibitors I February 18, 2021 A 70-year-old man with chronic lymphocytic leukemia (CLL) who started ibrutinib 3 months prior is referred from the hematology clinic to cardiology with new onset palpitations and dyspnea on exertion.
	Patient Case Quiz \| Anticoagulation Considerations in Patients With Chronic Lymphocytic Leukemia and Atrial Fibrillation I February 18, 2021 A 76-year-old woman with chronic lymphocytic leukemia (CLL) on ibrutinib is noted to be in asymptomatic atrial fibrillation on a routine ECG performed in the hematology clinic for consideration of clinical trial participation.
	Patient Case Quiz \| Management of Bleeding Complications in Patients With Chronic Lymphocytic Leukemia and Atrial Fibrillation I February 18, 2021 A 68-year-old man with chronic lymphocytic leukemia (CLL) presents to the emergency department with one day history of melena, chest discomfort, and lightheadedness.
	Expert Panel Discussion \| Managing Atrial Fibrillation and Bruton Tyrosine Kinase (BTK) Inhibitors: Balancing Risk – Part 1 I February 24, 2021 Expert Faculty discuss important questions such as the criteria to initiate and choose a BTK inhibitor, the CV adverse effects associated with BTK inhibitors, and how to monitor for them.
	Expert Panel Discussion \| Managing Atrial Fibrillation and Bruton Tyrosine Kinase (BTK) Inhibitors: Balancing Risk – Part 2 I February 24, 2021 Expert Faculty discuss important questions such as how to manage a major bleed, considerations when anti-coagulating patients on BTK inhibitors, and alternative oncologic treatment strategies in patients with cardiovascular complications
	JACC: CardioOncology JACC: CardioOncology serves to advance the cardiovascular care of cancer patients through the publication of rigorously executed, innovative science and dissemination of evidence-based knowledge. The journal seeks to transform the field of cardio-oncology and actively engage and educate the cardiovascular and oncology communities in pre-clinical, translational, and clinical research, as well as in best practices in cardio-oncology. Broad areas of interest include original research studies in disease mechanisms, in vitro and in vivo model systems, novel and conventional therapeutics (Phase I-IV), epidemiology, precision medicine, and primary and secondary prevention. Disease states of interest include, but are not limited to amyloidosis, cardiovascular risk factors, heart failure, and vascular disease.

We are grateful to the distinguished faculty who contributed to this collection:

Ana Barac, MD, PhD, FACC (Chair)
MedStar Heart and Vascular Institute

Anju Nohria, MD, MSc
Brigham and Women's Hospital

Jennifer R. Brown, MD, PhD
Dana-Farber Cancer Institute
Harvard Medical School

John Fanikos, RPH, MBA
Brigham and Women’s Hospital

Michael G. Fradley, MD
Penn Heart and Vascular Center
Penn Medicine

	Interactive Infographic: Anticoagulation for Atrial Fibrillation (AFib) in Patients Receiving Bruton Tyrosine Kinase (BTK) Inhibitors I June 1, 2021 This Interactive Infographic covers important topics such as patient-specific risk factors, antiplatelet activity of BTK inhibitors and drug-drug interactions, as well as the steps to anticoagulation and dosing requirements in different CLL patients.
	Patient Case Quiz \| Cardiovascular Adverse Effects of Bruton's Tyrosine Kinase (BTK) Inhibitors I February 18, 2021 A 66-year-old woman with Waldenstrom macroglobulinemia presents with progressive splenomegaly and fatigue.
	Patient Case Quiz \| Management of Atrial Fibrillation in Patients Treated with Bruton's Tyrosine Kinase (BTK) Inhibitors I February 18, 2021 A 70-year-old man with chronic lymphocytic leukemia (CLL) who started ibrutinib 3 months prior is referred from the hematology clinic to cardiology with new onset palpitations and dyspnea on exertion.
	Patient Case Quiz \| Anticoagulation Considerations in Patients With Chronic Lymphocytic Leukemia and Atrial Fibrillation I February 18, 2021 A 76-year-old woman with chronic lymphocytic leukemia (CLL) on ibrutinib is noted to be in asymptomatic atrial fibrillation on a routine ECG performed in the hematology clinic for consideration of clinical trial participation.
	Patient Case Quiz \| Management of Bleeding Complications in Patients With Chronic Lymphocytic Leukemia and Atrial Fibrillation I February 18, 2021 A 68-year-old man with chronic lymphocytic leukemia (CLL) presents to the emergency department with one day history of melena, chest discomfort, and lightheadedness.
	Expert Panel Discussion \| Managing Atrial Fibrillation and Bruton Tyrosine Kinase (BTK) Inhibitors: Balancing Risk – Part 1 I February 24, 2021 Expert Faculty discuss important questions such as the criteria to initiate and choose a BTK inhibitor, the CV adverse effects associated with BTK inhibitors, and how to monitor for them.
	Expert Panel Discussion \| Managing Atrial Fibrillation and Bruton Tyrosine Kinase (BTK) Inhibitors: Balancing Risk – Part 2 I February 24, 2021 Expert Faculty discuss important questions such as how to manage a major bleed, considerations when anti-coagulating patients on BTK inhibitors, and alternative oncologic treatment strategies in patients with cardiovascular complications
	JACC: CardioOncology JACC: CardioOncology serves to advance the cardiovascular care of cancer patients through the publication of rigorously executed, innovative science and dissemination of evidence-based knowledge. The journal seeks to transform the field of cardio-oncology and actively engage and educate the cardiovascular and oncology communities in pre-clinical, translational, and clinical research, as well as in best practices in cardio-oncology. Broad areas of interest include original research studies in disease mechanisms, in vitro and in vivo model systems, novel and conventional therapeutics (Phase I-IV), epidemiology, precision medicine, and primary and secondary prevention. Disease states of interest include, but are not limited to amyloidosis, cardiovascular risk factors, heart failure, and vascular disease.