Outcomes of patients with active cancers and pre-existing cardiovascular diseases infected with SARS-CoV-2

Brijesh Patel; Scott A Chapman; Jake T Neumann; Aayush Visaria; Oluwabunmi Ogungbe; Sijin Wen; Maryam Khodaverdi; Priyal Makwana; Jasvinder A Singh; George Sokos; N3C Consortium

doi:10.1186/s40959-023-00187-w

Outcomes of patients with active cancers and pre-existing cardiovascular diseases infected with SARS-CoV-2

Cardiooncology. 2023 Oct 6;9(1):36. doi: 10.1186/s40959-023-00187-w.

Authors

Brijesh Patel^{1

2}, Scott A Chapman³, Jake T Neumann⁴, Aayush Visaria⁵, Oluwabunmi Ogungbe⁶, Sijin Wen⁷, Maryam Khodaverdi⁸, Priyal Makwana⁸, Jasvinder A Singh^{8

9

10

11}, George Sokos¹²; N3C Consortium

Collaborators

N3C Consortium:
Adam B Wilcox, Adam M Lee, Alexis Graves, Alfred Jerrod Anzalone, Amin Manna, Amit Saha, Amy Olex, Andrea Zhou, Andrew E Williams, Andrew Southerland, Andrew T Girvin, Anita Walden, Anjali A Sharathkumar, Benjamin Amor, Benjamin Bates, Brian Hendricks, Caleb Alexander, Carolyn Bramante, Cavin Ward-Caviness, Charisse Madlock-Brown, Christine Suver, Christopher Chute, Christopher Dillon, Chunlei Wu, Clare Schmitt, Cliff Takemoto, Dan Housman, Davera Gabriel, David A Eichmann, Diego Mazzotti, Don Brown, Eilis Boudreau, Elaine Hill, Elizabeth Zampino, Emily Carlson Marti, Emily R Pfaff, Evan French, Farrukh M Koraishy, Federico Mariona, Fred Prior, Greg Martin, Harold Lehmann, Heidi Spratt, Hemalkumar Mehta, Hongfang Liu, Hythem Sidky, J W Awori Hayanga, Jami Pincavitch, Jaylyn Clark, Jeremy Richard Harper, Jessica Islam, Jin Ge, Joel Gagnier, Joel H Saltz, Joel Saltz, Johanna Loomba, John Buse, Jomol Mathew, Joni L Rutter, Julie A McMurry, Justin Guinney, Justin Starren, Karen Crowley, Katie Rebecca Bradwell, Kellie M Walters, Ken Wilkins, Kenneth R Gersing, Kenrick Dwain Cato, Kimberly Murray, Kristin Kostka, Lavance Northington, Lee Allan Pyles, Leonie Misquitta, Lesley Cottrell, Lili Portilla, Mariam Deacy, Mark M Bissell, Marshall Clark, Mary Emmett, Mary Morrison Saltz, Matvey B Palchuk, Melissa A Haendel, Meredith Adams, Meredith Temple-O'Connor, Michael G Kurilla, Michele Morris, Nabeel Qureshi, Nasia Safdar, Nicole Garbarini, Noha Sharafeldin, Ofer Sadan, Patricia A Francis, Penny Wung Burgoon, Peter Robinson, Philip R O Payne, Rafael Fuentes, Randeep Jawa, Rebecca Erwin-Cohen, Rena Patel, Richard A Moffitt, Richard L Zhu, Rishi Kamaleswaran, Robert Hurley, Robert T Miller, Saiju Pyarajan, Sam G Michael, Samuel Bozzette, Sandeep Mallipattu, Satyanarayana Vedula, Shawn T O'Neil, Soko Setoguchi, Stephanie S Hong, Steve Johnson, Tellen D Bennett, Tiffany Callahan, Umit Topaloglu, Usman Sheikh, Valery Gordon, Vignesh Subbian, Warren A Kibbe, Wenndy Hernandez, Will Beasley, Will Cooper, William Hillegass, Xiaohan Tanner Zhang

Affiliations

¹ Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA. brijesh.patel@wvumedicine.org.
² WVU School of Medicine, Non-Invasive Cardiologist and Cardio-Oncology, WVU Heart & Vascular Institute, 1 Medical Center Drive, Box 8500, Morgantown, WV, 26505, USA. brijesh.patel@wvumedicine.org.
³ Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, USA.
⁴ Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA.
⁵ Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
⁶ Johns Hopkins University, Baltimore, MD, USA.
⁷ Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA.
⁸ West Virginia Clinical and Transitional Science Institute, Morgantown, WV, USA.
⁹ Medicine Service, VA Medical Center, 700 19Th St S, Birmingham, AL, 35233, USA.
¹⁰ Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), 510 20th Street S, Birmingham, AL, 35294-0022, USA.
¹¹ Department of Epidemiology at the UAB School of Public Health, Ryals Public Health Building, 1665 University Blvd, Birmingham, AL, 35294-0022, USA.
¹² Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA.

Abstract

Objective: To determine the impact of acute SARS-CoV-2 infection on patient with concomitant active cancer and CVD.

Methods: The researchers extracted and analyzed data from the National COVID Cohort Collaborative (N3C) database between January 1, 2020, and July 22, 2022. They included only patients with acute SARS-CoV-2 infection, defined as a positive test by PCR 21 days before and 5 days after the day of index hospitalization. Active cancers were defined as last cancer drug administered within 30 days of index admission. The "Cardioonc" group consisted of patients with CVD and active cancers. The cohort was divided into four groups: (1) CVD (-), (2) CVD ( +), (3) Cardioonc (-), and (4) Cardioonc ( +), where (-) or ( +) denotes acute SARS-CoV-2 infection status. The primary outcome of the study was major adverse cardiovascular events (MACE), including acute stroke, acute heart failure, myocardial infarction, or all-cause mortality. The researchers analyzed the outcomes by different phases of the pandemic and performed competing-risk analysis for other MACE components and death as a competing event.

Results: The study analyzed 418,306 patients, of which 74%, 10%, 15.7%, and 0.3% had CVD (-), CVD ( +), Cardioonc (-), and Cardioonc ( +), respectively. The Cardioonc ( +) group had the highest MACE events in all four phases of the pandemic. Compared to CVD (-), the Cardioonc ( +) group had an odds ratio of 1.66 for MACE. However, during the Omicron era, there was a statistically significant increased risk for MACE in the Cardioonc ( +) group compared to CVD (-). Competing risk analysis showed that all-cause mortality was significantly higher in the Cardioonc ( +) group and limited other MACE events from occurring. When the researchers identified specific cancer types, patients with colon cancer had higher MACE.

Conclusion: In conclusion, the study found that patients with both CVD and active cancer suffered relatively worse outcomes when they had acute SARS-CoV-2 infection during early and alpha surges in the United States. These findings highlight the need for improved management strategies and further research to better understand the impact of the virus on vulnerable populations during the COVID-19 pandemic.

Abstract

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