Abstract
BackgroundWhile 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.MethodsData 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.ResultsAmong 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).ConclusionAmong 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.
Highlights
The novel coronavirus Severe Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to the ongoing and relentless global Coronavirus Disease 2019 (COVID19) pandemic, and was the leading cause of death in the Tehrani et al Cardio-Oncology (2021) 7:28United States in 2020 (US) [1, 2]
To address this evidence gap, we evaluated the association of history of cardiovascular disease (CVD), history of cancer, and recent cancer-related therapy with in-hospital death, as well as other adverse cardiovascular, pulmonary, and venous thromboembolic outcomes among adult patients hospitalized with COVID-19 in the multicenter American Heart Association’s (AHA) COVID-19 Cardiovascular disease (CVD) Registry powered by Get With The Guidelines (GWTG)
History of cancer was a significant predictor of in-hospital mortality (OR = 1.62, 95%confidence intervals (CI): 1.38–1.91, p < 0.0001)
Summary
The novel coronavirus Severe Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to the ongoing and relentless global Coronavirus Disease 2019 (COVID19) pandemic, and was the leading cause of death in the Tehrani et al Cardio-Oncology (2021) 7:28United States in 2020 (US) [1, 2]. Underlying cardiovascular disease (CVD) risk factors and CVD are important prognosticators of clinical outcomes in hospitalized patients with COVID-19 [3]. Data on the impact of COVID-19 in patients with a history of prior or active cancer who have underlying or acquired CVD from cancer-related treatments—the cardio-oncology population—is limited. As oncologists and cardio-oncologists weigh the risk and benefits of initiating versus delaying or continuing versus stopping cancer-related therapies in light of the ongoing pandemic, it is critical to understand the impact of COVID-19 in the cancer population, and among those with concomitant CVD. 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-hospi‐ tal mortality in those with COVID-19
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