Impact of cancer and cardiovascular disease on in-hospital outcomes of COVID-19 patients: results from the american heart association COVID-19 cardiovascular disease registry

Cardio-Oncology - Tập 7 Số 1 - 2021
David M. Tehrani1, Xiaoyan Wang2, Asim Rafique1, Salim S. Hayek3, Joerg Herrmann4, Tomas G. Neilan5, Pooja Desai6, Alicia K. Morgans7, Juan Lopez‐Mattei8, Rushi V. Parikh1, Eric H. Yang9
1Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA
2Division of General Internal Medicine and Health Service Research, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA
3Division of Cardiology, Department of Medicine, Michigan Medicine, Ann Arbor, MI, USA
4Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
5Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
6Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA
7Division of Hematology and Oncology, Department of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
8Division of Cardiology, Department of Medicine, Texas MD Anderson Cancer Center, Houston, TX, USA
9UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA

Tóm tắt

Abstract Background While pre-existing cardiovascular disease (CVD) appears to be associated with poor outcomes in patients with Coronavirus Disease 2019 (COVID-19), data on patients with CVD and concomitant cancer is limited. The purpose of this study is to evaluate the effect of underlying CVD and CVD risk factors with cancer history on in-hospital mortality in those with COVID-19. Methods Data from symptomatic adults hospitalized with COVID-19 at 86 hospitals in the US enrolled in the American Heart Association’s COVID-19 CVD Registry was analyzed. The primary exposure was cancer history. The primary outcome was in-hospital death. Multivariable logistic regression models were adjusted for demographics, CVD risk factors, and CVD. Interaction between history of cancer with concomitant CVD and CVD risk factors were tested. Results Among 8222 patients, 892 (10.8%) had a history of cancer and 1501 (18.3%) died. Cancer history had significant interaction with CVD risk factors of age, body mass index (BMI), and smoking history, but not underlying CVD itself. History of cancer was significantly associated with increased in-hospital death (among average age and BMI patients, adjusted odds ratio [aOR] = 3.60, 95% confidence interval [CI]: 2.07–6.24; p < 0.0001 in those with a smoking history and aOR = 1.33, 95%CI: 1.01—1.76; p = 0.04 in non-smokers). Among the cancer subgroup, prior use of chemotherapy within 2 weeks of admission was associated with in-hospital death (aOR = 1.72, 95%CI: 1.05–2.80; p = 0.03). Underlying CVD demonstrated a numerical but statistically nonsignificant trend toward increased mortality (aOR = 1.18, 95% CI: 0.99—1.41; p = 0.07). Conclusion Among hospitalized COVID-19 patients, cancer history was a predictor of in-hospital mortality. Notably, among cancer patients, recent use of chemotherapy, but not underlying CVD itself, was associated with worse survival. These findings have important implications in cancer therapy considerations and vaccine distribution in cancer patients with and without underlying CVD and CVD risk factors.

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Cardio-Oncology

Tập 7 Số 1

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