COVID-19 and acute heart failure among patients with cancer
Date Issued
2022-10-01
Author(s)
Bergami, M
Fabin, N
Mjehovic, P
Pasalic, M
Scarpone, M
Vasiljevic, Z
Vega Pittao, M L
Vukomanovic, V
Mancuso, G
David, A
Caramori, G
Nava, S
Manfrini, O
Bugiardini, R
DOI
10.1093/eurheartj/ehac544.2584
Abstract
Background: Patients with cancer represent a uniquely vulnerable population
not only with higher susceptibility to COVID-19 but also at increased
risk for death. However, detailed information on causes of death and the
contribution of pre-existing health conditions to death yet is missing.
Purpose: This study focuses on the implications of COVID-19 in the cardiovascular
health of patients with cancer by assessing the relation between
cancer and de novo acute heart failure (AHF) with in-hospital mortality.
Methods: The initial population consisted of 3968 patients included in the
ISACS COVID-19 registry between March 2020 and February 2022. Of
these, 546 patients with chronic HF were excluded, leaving a final population
of 3422. Patients were divided in two groups according to the presence
or absence of a cancer diagnosis at the time of hospitalization for COVID-
19. Primary outcomes were incidence of in-hospital mortality or AHF during
hospitalization. Association between cancer and outcomes was estimated
using multivariable logistic regression analyses. Subsidiary analysis was
conducted to evaluate differences between patients with prior vs active
cancer.
Results: Of the 3422 patients included in the study, 468 patients had cancer
(8.2% active, 5.5% past cancer). Cancer patients were older (68.9±13.4
vs 63.3±15.6, p-value <0.001) and more likely to be female (50.4% vs
39.1%, p-value <0.001). They presented more frequently with a history of
chronic obstructive pulmonary disease (12.3% vs 7.6%, p-value = 0.001).
When considering outcomes, cancer patients had a significantly higher incidence
of in-hospital mortality (27.7% vs 19.2%; p-value <0.001). This despite
the presence of a numerically higher mean PiO2/FiO2 (281±108.8 vs
267.05±122.5, p-value = 0.11) on admission and a lower rate of X-ray findings
of interstitial pneumonia (60% vs 70.5%, p-value <0.001) than their
non-oncological counterparts, as well as similar use of mechanical ventilation
(30.6% vs 35.0%, p value=0.14). The association between cancer and
death persisted when adjusting for demographic, laboratory findings and
in-hospital treatment (OR: 1.46; 95% CI: 1.11–1.94; p value=0.01). Cancer
patients also had higher rates of AHF (9.6% vs 4.7%, p-value <0.001)
during hospitalization. This association was independent from presence of
cardiovascular risk factors or comorbidities (OR: 1.61; 95% CI: 1.07–2.43;
p value=0.02). When restricting the analysis to the cancer population, AHF
appeared to be significantly associated with death (OR: 2.41; 95% CI 1.18–
4.95; p-value = 0.01), but this correlation persisted only in patients affected
by active cancer in age and sex adjusted analyses (OR: 4.27; 95% CI:
1.51–12.07; p value=0.01 vs 1.20; 95% CI: 0.38–3.76; p-value = 0.75).
Conclusions: The incidence of AHF in cancer patients with COVID-19 is
high. Patients with active cancer are also at high risk for mortality. This
has implications for cardiac monitoring and chemotherapy administration
during COVID-19.
not only with higher susceptibility to COVID-19 but also at increased
risk for death. However, detailed information on causes of death and the
contribution of pre-existing health conditions to death yet is missing.
Purpose: This study focuses on the implications of COVID-19 in the cardiovascular
health of patients with cancer by assessing the relation between
cancer and de novo acute heart failure (AHF) with in-hospital mortality.
Methods: The initial population consisted of 3968 patients included in the
ISACS COVID-19 registry between March 2020 and February 2022. Of
these, 546 patients with chronic HF were excluded, leaving a final population
of 3422. Patients were divided in two groups according to the presence
or absence of a cancer diagnosis at the time of hospitalization for COVID-
19. Primary outcomes were incidence of in-hospital mortality or AHF during
hospitalization. Association between cancer and outcomes was estimated
using multivariable logistic regression analyses. Subsidiary analysis was
conducted to evaluate differences between patients with prior vs active
cancer.
Results: Of the 3422 patients included in the study, 468 patients had cancer
(8.2% active, 5.5% past cancer). Cancer patients were older (68.9±13.4
vs 63.3±15.6, p-value <0.001) and more likely to be female (50.4% vs
39.1%, p-value <0.001). They presented more frequently with a history of
chronic obstructive pulmonary disease (12.3% vs 7.6%, p-value = 0.001).
When considering outcomes, cancer patients had a significantly higher incidence
of in-hospital mortality (27.7% vs 19.2%; p-value <0.001). This despite
the presence of a numerically higher mean PiO2/FiO2 (281±108.8 vs
267.05±122.5, p-value = 0.11) on admission and a lower rate of X-ray findings
of interstitial pneumonia (60% vs 70.5%, p-value <0.001) than their
non-oncological counterparts, as well as similar use of mechanical ventilation
(30.6% vs 35.0%, p value=0.14). The association between cancer and
death persisted when adjusting for demographic, laboratory findings and
in-hospital treatment (OR: 1.46; 95% CI: 1.11–1.94; p value=0.01). Cancer
patients also had higher rates of AHF (9.6% vs 4.7%, p-value <0.001)
during hospitalization. This association was independent from presence of
cardiovascular risk factors or comorbidities (OR: 1.61; 95% CI: 1.07–2.43;
p value=0.02). When restricting the analysis to the cancer population, AHF
appeared to be significantly associated with death (OR: 2.41; 95% CI 1.18–
4.95; p-value = 0.01), but this correlation persisted only in patients affected
by active cancer in age and sex adjusted analyses (OR: 4.27; 95% CI:
1.51–12.07; p value=0.01 vs 1.20; 95% CI: 0.38–3.76; p-value = 0.75).
Conclusions: The incidence of AHF in cancer patients with COVID-19 is
high. Patients with active cancer are also at high risk for mortality. This
has implications for cardiac monitoring and chemotherapy administration
during COVID-19.
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