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CV Admissions on the Rise in Americans With Cancer

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While cardiovascular disease (CVD) is known to often be a fatal blow to cancer patients, a national analysis dramatically eases the burden of CVD-related hospitalizations among this vulnerable population.

The results show that between 2004 and 2017, the number of hospitalizations for cardiovascular diseases increased by 23.2% among patients diagnosed with cancer, while among patients without cancer, the number of hospitalizations decreased by 10.9%.

Hospital admissions rose steadily for all types of cancer except prostate cancer, with heart failure being the most common cause of hospitalization.

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“Admission to a hospital is really important because we know that the size of this group is increasing given that they are living longer and many of the treatments we offer cause cardiovascular disease or increase the risk of cardiovascular events. So, in terms of health planning. I think it’s very important to see what the burden will be in the next few years,” senior author Mamas Mamas, MD, University of Keele, England, told theheart.org | Medscape Cardiology.

For physicians and the wider population, he says, the results highlight the need to shift the conversation away from the notion that patients with cancer are at increased risk of cardiovascular disease to how to reduce that risk. “Because I would say that this increase in the number of hospitalizations for cardiovascular diseases is a failure from a preventive point of view.”

The study was published August 1 in the European Heart Journal: Quality of Care & Clinical Outcomes.

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Individual types of cancer

Researchers led by Ofer Kobo, MD, also from the University of Kiel, used the National Inpatient Sample to identify 42.5 million weighted CV hospitalizations for acute myocardial infarction (AMI), pulmonary embolism, ischemic stroke, heart failure, atrial fibrillation (AF). ), or atrial flutter and intracranial hemorrhage from January 2004 to December 2017. Of these, 1.9 million had cancer.

The cancer patients were older; had a higher prevalence of valvular disease, anemia, and coagulopathy; and lower prevalence of hypertension, diabetes mellitus, and obesity than in patients without cancer.

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The most common type of cancer was hematological (26.1%), followed by lung (18.7%), gastrointestinal (12.4%), prostate (11.6%), breast (6.7%) ) and others at 24.4%.

Hospitalization rates increased for all six reasons for hospitalization, from 7% for AMI and ischemic stroke to 46% for AF.

Heart failure was the leading cause of hospitalization among all patients. Annual rates per 100,000 US population increased in patients with cancer (from 13.6 to 16.6; P for trend = 0.02) and decreased in patients without cancer (from 352.2 to 349.8; P for trend < 0.001).

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“In the past, patients were started on medication, and perhaps the importance of monitoring [left ventricular] LV function was not as widely known, whereas now we are looking at it much more aggressively and trying to prevent it much more aggressively,” Mamas said. re continues to receive a very substantial increase in heart failure hospitalizations in this population. And what really surprised me was that it was not only in the breast cancer population, but almost everywhere.”

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He noted that patients are at greatest risk of cardiovascular events during the first 2 years after being diagnosed with cancer. “So this is really the time when you have to be very aggressive in finding and working with their cardiovascular profile.”

Patients with hematologic cancer (9.7–13.5), lung cancer (7.4–8.9), and gastrointestinal cancer (4.6–6.3) had the highest overall rates of cardiac hospital admissions. – vascular disease per 100,000 US population.

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The rate of hospitalizations for cardiovascular disease increased from 2.5 to 3.7 per 100,000 US population for breast cancer, and for prostate cancer, the rate decreased from 5.8 to 4.8 per 100,000 US population.

Of note, patients with hematologic cancer also had the highest rate of hospitalizations for heart failure of any type of cancer, which, combined with their increasing rates of hospitalizations, likely reflects their exposure to a “cardiotoxic constellation of therapies” as well as pathological processes. associated with heart failure. crayfish themselves, the authors suggest.

The in-hospital mortality rate was higher among patients with cancer than without cancer, ranging from 5% for patients with breast cancer to 9.6% for patients with lung cancer compared to 4.2% for patients without cancer.

Among cancer patients, the mortality odds ratio was highest in patients hospitalized with AF (4.43), followed by pulmonary embolism (2.36), MI (2.31), ischemic stroke (2.29), and heart failure ( 2.24).

Consistent with previous work and general population trends, in-hospital mortality during primary CV hospitalization tended to decrease among cancer patients over the study period.

Risk reduction

Commenting on the study, Joerg Herrmann, MD, director of the Cardiac Oncology Clinic at the Mayo Clinic in Rochester, Minnesota, said the data is “extremely important” as it reflects hospitalizations in a new era of cancer treatment. “All targeted therapies appeared around the turn of the millennium, so we’re not really looking at cancer patients who were only being treated with old and ancient strategies.”

This may be one reason for the increase in hospital admissions, but because the study lacked information about specific cancer treatments and the date the cancer was diagnosed, it is impossible to know if this spike is due to cardiotoxicity or because oncology treatment outcomes have improved enough that this is a growing population. , he said.

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However, one clear implication is that someone who works in the hospital service will see more patients diagnosed with cancer, Herrmann noted.

“While some may have tried not to get too carried away with this topic, it does require a broader scope to get to know this very entity,” he said. “And this shows up, in particular, in patients diagnosed with active cancer.”

Herrmann and colleagues previously reported that patients with active leukemia or lymphoma who were hospitalized for acute coronary syndrome were less likely to receive treatment as recommended, even at the Mayo Clinic.

Similarly, in a report by Mamas et al. in 2020, it was found that patients with various active cancers received the same benefit from primary percutaneous coronary intervention for ST-segment elevation MI as patients without cancer, but were treated less frequently.

Mamas noted that while there is greater recognition that cancer patients equally benefit from aggressive treatment, much more can be done to reduce cardiovascular risk. Valuable coronary information obtained from MRI and CT scans performed as part of cancer research is often overlooked. For example, “We know that breast calcification and vascular calcification in the breast are very strong predictors of CVD, but people don’t use this information.”

There are many common risk factors in the development of cancer and coronary heart disease, he says, and patients with cancer often have much worse CV risk profiles but do not typically undergo CV risk stratification.

Mamas said his team is also looking into whether CVD risk prediction tools, such as the Framingham Risk Score, which have been obtained in non-cancer populations, work in patients with cancer. “Often when you look at the effectiveness of these tools in populations that have not been reached, they are much worse.”

“Many cancer survivors worry about their cancer coming back and will piously do re-scans, religiously check themselves and go through all these tests, but don’t think about the real risk that is higher for them, which is the risk of cardiovascular disease. ,” he said.

The authors do not report funding for the study or related financial relationships.

Results of Eur Heart J Qual Clin. Published online August 1, 2022 Abstract

Follow Patrice Wendling on Twitter: @pwendl. Read more at theheart.org | Medscape Cardiology, follow us on Twitter and Facebook

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