COVID-19 RELATED OUTCOMES IN PATIENTS WITH PREEXISTING CARDIOVASCULAR DISEASES, WITH OR WITHOUT CANCER

Background:

Preexisting cardiovascular disease (CVD) conditions have prognostic implications in COVID-19. Further, cancer and CVD may co-exist (Cardio-onc), leading to unfavorable outcomes. Our objective is to assess differential outcomes of COVID-19 infection among hospitalized patients with Cardio-oncologic conditions.

Methods:

Patient data were retrospectively collected from the National COVID Cohort Collaborative (N3C) from March 2020 to September 2021. CVD only or Cardio-onc patients confirmed COVID-19 positive (+) or negative (-) by RT-PCR 21 days prior to and 5 days after admission date were included and divided into four groups: (1) CVD (+); (2) CVD (-); (3) Cardio-onc (+); and (4) Cardio-onc (-). Cancer patients who received chemotherapy within 30 days of admission were included. The primary outcome was MACE events (myocardial infarction, stroke, heart failure, and 30-day mortality) during hospitalization. 30-day mortality was defined as fatalities occurring during hospitalization and 30-day post-hospital discharge. Secondary outcomes were the use of a mechanical ventilator, extracorporeal membrane oxygenation, and hospital length of stay. A generalized linear model was used to calculate the adjusted odds ratio (aOR) and 95% confidence interval after adjusting for demographics and covariates.

Results:

503, 995 patients (mean (SD) age of 66 (15) years;45% female).408,197 (81%) were CVD (-), 76,528 (15%) were CVD (+), 18,222 (3%) were Cardio-onc (-), and 3,126 (1%) were Cardio-onc (+). Using CVD (-) as the reference group, the aOR (95%CI) for MACE was 1.12 (1.10-1.14) for CVD (+), 0.95 (0.92-0.99) for Cardio-onc (-), and 1.30 (1.21-1.40) for Cardio-onc (+). The 30-day mortality was significantly higher in the Cardio-onc (+) group (aOR 3.89 (3.55-4.27)), than Cardio-onc (-) 1.83 (1.74-1.92) and CVD (+) 2.68 (2.61-2.75) compared to CVD (-). The secondary outcomes were significantly higher in the Cardio-onc (+) than the other three groups.

Conclusion:

Patients with COVID-19 infection with underlying CVD had an increased risk of MACE and 30-day mortality. Concomitant cancer diagnosis further increased the risk of 30-day mortality.