Cardiac events among a cohort of 17,389 patients receiving cancer chemotherapy: short and long term implications

Saifei Liu; John D. Horowitz; Bogda Koczwara; Aaron L. Sverdlov; Natalie Packer; Robyn A. Clark

doi:10.1186/s40959-024-00269-3

Cardiac events among a cohort of 17,389 patients receiving cancer chemotherapy: short and long term implications

Saifei Liu, John D. Horowitz, Bogda Koczwara, Aaron L. Sverdlov, Natalie Packer, Robyn A. Clark

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Abstract

Background: The association between cardiovascular disease and carcinogenesis is bidirectional and well-established. Furthermore, cancer treatment improves overall patient survival, potentially at the cost of incremental and fatal cardiovascular disease (CVD).

Aim: To evaluate (a) In a real-world cohort, the proportion of patients offered cancer chemotherapy who have antecedent CVD (CVD_A); (b) The rates of patient admission with subsequent development of CVD (CVD_S) requiring hospital admission post assignment to chemotherapy; (c) The impact of CVD_A and CVD_S on mortality rates relative to those seen in patients without overt CVD (CVD⁻) and (d) The time course of mortality in CVD⁻ versus CVD_S patients.

Methods: Retrospective analysis was performed in deidentified linked health data sets. Correlates of mortality were evaluated by Cox proportional hazards evaluation. Relative and absolute time-variability of CVD as a primary cause of death were determined.

Results: Of the total 17,389 patients, there were 2,159 with CVD_A. Over a median follow-up time of 4.6 years, CVD_S admissions (n = 8,529) occurred more commonly in the presence of CVD_A (70.0% vs. 46.1%, p < 0.001), and more than 50% of CVD_S cases occurred in the first 12 months of follow-up. The 5-year mortality rates were 71.5% for CVD_A, 64.7% for CVD_S, and 40.8% for CVD⁻ (p < 0.001). Development of CVD_S was associated with a substantially increased risk of mortality in the next 12 months. The development of CVDs was also associated with an increased risk of cardiovascular, as against non-cardiovascular, mortality (7.1% vs. 1.6%, p < 0.001).

Conclusions: Approximately 50% of patients assigned to cancer chemotherapy developed CVD_S, heralding a particularly high risk of mortality over the next 12 months. Both CVD_A and CVD_S are associated with substantial increases in mortality rates relative to those in CVD⁻ patients. This increased risk merits close individual monitoring.

Original language	English
Article number	72
Number of pages	11
Journal	Cardio-Oncology
Volume	10
Issue number	1
DOIs	https://doi.org/10.1186/s40959-024-00269-3
Publication status	Published - 16 Oct 2024

Keywords

Cardiotoxicity
Chemotherapy
Clinical outcomes
CVD
Linked-data

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s40959-024-00269-3Licence: CC BY-NC-ND

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title = "Cardiac events among a cohort of 17,389 patients receiving cancer chemotherapy: short and long term implications",

abstract = "Background: The association between cardiovascular disease and carcinogenesis is bidirectional and well-established. Furthermore, cancer treatment improves overall patient survival, potentially at the cost of incremental and fatal cardiovascular disease (CVD). Aim: To evaluate (a) In a real-world cohort, the proportion of patients offered cancer chemotherapy who have antecedent CVD (CVDA); (b) The rates of patient admission with subsequent development of CVD (CVDS) requiring hospital admission post assignment to chemotherapy; (c) The impact of CVDA and CVDS on mortality rates relative to those seen in patients without overt CVD (CVD−) and (d) The time course of mortality in CVD− versus CVDS patients. Methods: Retrospective analysis was performed in deidentified linked health data sets. Correlates of mortality were evaluated by Cox proportional hazards evaluation. Relative and absolute time-variability of CVD as a primary cause of death were determined. Results: Of the total 17,389 patients, there were 2,159 with CVDA. Over a median follow-up time of 4.6 years, CVDS admissions (n = 8,529) occurred more commonly in the presence of CVDA (70.0% vs. 46.1%, p < 0.001), and more than 50% of CVDS cases occurred in the first 12 months of follow-up. The 5-year mortality rates were 71.5% for CVDA, 64.7% for CVDS, and 40.8% for CVD− (p < 0.001). Development of CVDS was associated with a substantially increased risk of mortality in the next 12 months. The development of CVDs was also associated with an increased risk of cardiovascular, as against non-cardiovascular, mortality (7.1% vs. 1.6%, p < 0.001). Conclusions: Approximately 50% of patients assigned to cancer chemotherapy developed CVDS, heralding a particularly high risk of mortality over the next 12 months. Both CVDA and CVDS are associated with substantial increases in mortality rates relative to those in CVD− patients. This increased risk merits close individual monitoring.",

keywords = "Cardiotoxicity, Chemotherapy, Clinical outcomes, CVD, Linked-data",

author = "Saifei Liu and Horowitz, {John D.} and Bogda Koczwara and Sverdlov, {Aaron L.} and Natalie Packer and Clark, {Robyn A.}",

year = "2024",

month = oct,

day = "16",

doi = "10.1186/s40959-024-00269-3",

language = "English",

volume = "10",

journal = "Cardio-Oncology",

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TY - JOUR

T1 - Cardiac events among a cohort of 17,389 patients receiving cancer chemotherapy

T2 - short and long term implications

AU - Liu, Saifei

AU - Horowitz, John D.

AU - Koczwara, Bogda

AU - Sverdlov, Aaron L.

AU - Packer, Natalie

AU - Clark, Robyn A.

PY - 2024/10/16

Y1 - 2024/10/16

N2 - Background: The association between cardiovascular disease and carcinogenesis is bidirectional and well-established. Furthermore, cancer treatment improves overall patient survival, potentially at the cost of incremental and fatal cardiovascular disease (CVD). Aim: To evaluate (a) In a real-world cohort, the proportion of patients offered cancer chemotherapy who have antecedent CVD (CVDA); (b) The rates of patient admission with subsequent development of CVD (CVDS) requiring hospital admission post assignment to chemotherapy; (c) The impact of CVDA and CVDS on mortality rates relative to those seen in patients without overt CVD (CVD−) and (d) The time course of mortality in CVD− versus CVDS patients. Methods: Retrospective analysis was performed in deidentified linked health data sets. Correlates of mortality were evaluated by Cox proportional hazards evaluation. Relative and absolute time-variability of CVD as a primary cause of death were determined. Results: Of the total 17,389 patients, there were 2,159 with CVDA. Over a median follow-up time of 4.6 years, CVDS admissions (n = 8,529) occurred more commonly in the presence of CVDA (70.0% vs. 46.1%, p < 0.001), and more than 50% of CVDS cases occurred in the first 12 months of follow-up. The 5-year mortality rates were 71.5% for CVDA, 64.7% for CVDS, and 40.8% for CVD− (p < 0.001). Development of CVDS was associated with a substantially increased risk of mortality in the next 12 months. The development of CVDs was also associated with an increased risk of cardiovascular, as against non-cardiovascular, mortality (7.1% vs. 1.6%, p < 0.001). Conclusions: Approximately 50% of patients assigned to cancer chemotherapy developed CVDS, heralding a particularly high risk of mortality over the next 12 months. Both CVDA and CVDS are associated with substantial increases in mortality rates relative to those in CVD− patients. This increased risk merits close individual monitoring.

AB - Background: The association between cardiovascular disease and carcinogenesis is bidirectional and well-established. Furthermore, cancer treatment improves overall patient survival, potentially at the cost of incremental and fatal cardiovascular disease (CVD). Aim: To evaluate (a) In a real-world cohort, the proportion of patients offered cancer chemotherapy who have antecedent CVD (CVDA); (b) The rates of patient admission with subsequent development of CVD (CVDS) requiring hospital admission post assignment to chemotherapy; (c) The impact of CVDA and CVDS on mortality rates relative to those seen in patients without overt CVD (CVD−) and (d) The time course of mortality in CVD− versus CVDS patients. Methods: Retrospective analysis was performed in deidentified linked health data sets. Correlates of mortality were evaluated by Cox proportional hazards evaluation. Relative and absolute time-variability of CVD as a primary cause of death were determined. Results: Of the total 17,389 patients, there were 2,159 with CVDA. Over a median follow-up time of 4.6 years, CVDS admissions (n = 8,529) occurred more commonly in the presence of CVDA (70.0% vs. 46.1%, p < 0.001), and more than 50% of CVDS cases occurred in the first 12 months of follow-up. The 5-year mortality rates were 71.5% for CVDA, 64.7% for CVDS, and 40.8% for CVD− (p < 0.001). Development of CVDS was associated with a substantially increased risk of mortality in the next 12 months. The development of CVDs was also associated with an increased risk of cardiovascular, as against non-cardiovascular, mortality (7.1% vs. 1.6%, p < 0.001). Conclusions: Approximately 50% of patients assigned to cancer chemotherapy developed CVDS, heralding a particularly high risk of mortality over the next 12 months. Both CVDA and CVDS are associated with substantial increases in mortality rates relative to those in CVD− patients. This increased risk merits close individual monitoring.

KW - Cardiotoxicity

KW - Chemotherapy

KW - Clinical outcomes

KW - CVD

KW - Linked-data

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DO - 10.1186/s40959-024-00269-3

M3 - Article

AN - SCOPUS:85206444536

SN - 2057-3804

VL - 10

JO - Cardio-Oncology

JF - Cardio-Oncology

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ER -

Cardiac events among a cohort of 17,389 patients receiving cancer chemotherapy: short and long term implications

Abstract

Keywords

UN SDGs

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