COVID-19 severity and cardiovascular outcomes in SARS-CoV-2-infected patients with cancer and cardiovascular disease |
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| Affiliation: | 1. Department of Cardiovascular Disease, Vidant Medical Center/East Carolina University, Greenville, NC, United States;2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States;3. Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, United States;4. Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, United States;5. Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, United States;6. Mays Cancer Center at UTHealth San Antonio MD Anderson, San Antonio, TX, United States;7. Section of Cardiology, University of Chicago Medical Center, Chicago, IL, United States;8. Dana-Farber Cancer Institute, Boston, MA, United States;9. Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States;10. Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States;11. Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida Morsani College of Medicine and Moffitt Cancer Center, Tampa, FL, United States;12. University of Washington, Seattle, WA, United States;13. Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States;14. Department of Medicine, University of Chicago, Chicago, IL, United States;15. University of Cincinnati Cancer Center, Cincinnati, OH, United States;p. Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, United States;q. University of Michigan Rogel Cancer Center, Ann Arbor, MI, United States;r. Division of Hematology and Medical Oncology, Knight Cancer Institute at Oregon Health and Science University, Portland, OR, United States;s. Stanford Cancer Institute at Stanford University, Stanford, CA, United States;t. Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States;u. UCSF Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, United States;v. Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States;w. Moores Cancer Center, University of California San Diego, La Jolla, CA, United States;x. Division of Medical Oncology and Hematology, Loma Linda University, Loma Linda, CA, United States;y. Cardio-Oncology, Hartford HealthCare Cancer, Hartford, CT, United States;z. Virtua Health, Marlton, NJ, United States;11. The University of Kansas Health System, Kansas City, KS, United States;12. Mayo Clinic, Rochester, MN, United States;13. Brown University and Lifespan Cancer Institute, Providence, RI, United States;14. Memorial Sloan-Kettering Cancer Center, New York, NY, United States;15. MD Anderson Cancer Center, Houston, TX, United States;16. Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, United States;17. Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States;18. Loyola University Medical Center, Chicago, IL, United States;19. Winship Cancer Institute of Emory University, Emory University, Atlanta, GA, United States;110. Herbert Irving Comprehensive Cancer Center at Columbia University, New York, NY, United States;111. Northwest Medical Specialties, Tacoma, WA, United States;112. Mount Auburn Hospital, Cambridge, MA, United States;113. St. Elizabeth Healthcare, Edgewood, KY, United States;114. Segal Cancer Centre, Jewish General Hospital, McGill University, Montréal, QC, Canada;115. McGill University Health Centre, Montréal, QC, Canada;1p. Instituto Nacional de Cancerología, Mexico City, Mexico;1q. Cleveland Clinic, Cleveland, OH, United States;1r. Cardiovascular Division, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, MA, United States;1s. Fred Hutchinson Cancer Research Center, Seattle, WA, United States |
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| Abstract: | BackgroundData regarding outcomes among patients with cancer and co-morbid cardiovascular disease (CVD)/cardiovascular risk factors (CVRF) after SARS-CoV-2 infection are limited.ObjectivesTo compare Coronavirus disease 2019 (COVID-19) related complications among cancer patients with and without co-morbid CVD/CVRF.MethodsRetrospective cohort study of patients with cancer and laboratory-confirmed SARS-CoV-2, reported to the COVID-19 and Cancer Consortium (CCC19) registry from 03/17/2020 to 12/31/2021. CVD/CVRF was defined as established CVD or no established CVD, male ≥ 55 or female ≥ 60 years, and one additional CVRF. The primary endpoint was an ordinal COVID-19 severity outcome including need for hospitalization, supplemental oxygen, intensive care unit (ICU), mechanical ventilation, ICU or mechanical ventilation plus vasopressors, and death. Secondary endpoints included incident adverse CV events. Ordinal logistic regression models estimated associations of CVD/CVRF with COVID-19 severity. Effect modification by recent cancer therapy was evaluated.ResultsAmong 10,876 SARS-CoV-2 infected patients with cancer (median age 65 [IQR 54–74] years, 53% female, 52% White), 6253 patients (57%) had co-morbid CVD/CVRF. Co-morbid CVD/CVRF was associated with higher COVID-19 severity (adjusted OR: 1.25 [95% CI 1.11–1.40]). Adverse CV events were significantly higher in patients with CVD/CVRF (all p<0.001). CVD/CVRF was associated with worse COVID-19 severity in patients who had not received recent cancer therapy, but not in those undergoing active cancer therapy (OR 1.51 [95% CI 1.31–1.74] vs. OR 1.04 [95% CI 0.90–1.20], pinteraction <0.001).ConclusionsCo-morbid CVD/CVRF is associated with higher COVID-19 severity among patients with cancer, particularly those not receiving active cancer therapy. While infrequent, COVID-19 related CV complications were higher in patients with comorbid CVD/CVRF. (COVID-19 and Cancer Consortium Registry [CCC19]; NCT04354701). |
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