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

David M Tehrani; Xiaoyan Wang; Asim M Rafique; Salim S Hayek; Joerg Herrmann; Tomas G Neilan; Pooja Desai; Alicia Morgans; Juan Lopez-Mattei; Rushi V Parikh; Eric H Yang

doi:10.1186/s40959-021-00113-y

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

Cardiooncology. 2021 Aug 10;7(1):28. doi: 10.1186/s40959-021-00113-y.

Authors

Affiliations

¹ Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA.
² Division of General Internal Medicine and Health Service Research, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA.
³ Division of Cardiology, Department of Medicine, Michigan Medicine, Ann Arbor, MI, USA.
⁴ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
⁵ Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁶ Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA.
⁷ Division of Hematology and Oncology, Department of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA.
⁸ Division of Cardiology, Department of Medicine, Texas MD Anderson Cancer Center, Houston, TX, USA.
⁹ Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA. Ehyang@mednet.ucla.edu.
¹⁰ UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA. Ehyang@mednet.ucla.edu.

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.

Keywords: COVID-19; Cancer; Cardiovascular disease; Malignancy; Mortality; Severe disease; Thromboembolic disease.

Abstract

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