Association of hematological cancer with characteristics, causes and outcomes of patients with cardiovascular admissions

Data on the characteristics and outcomes of patients with hematological cancers undergoing cardiovascular (CV) admissions in real-world settings are limited. This study utilized data from the National Inpatient Sample (2016-2020), including all CV admissions. Patients were stratified based on the presence of hematological cancers and their subtypes. The primary outcome was the cause of CV admission, and the secondary outcome was all-cause mortality. Descriptive statistics and multivariable logistic regression (adjusted odds ratios aOR) were used to compare outcomes across groups. Out of 5,957,492 CV admissions, 78,670 (1.3%) patients were admitted with hematological cancer. These patients were older (median age 75 vs. 70-72 years) and had a higher prevalence of comorbidities like atrial fibrillation, thrombocytopenia, anemia, congestive heart failure, valvular disease, coagulopathy and chronic renal failure, compared with patients with other cancer and those without cancer. Hypertension was the most common cause of CV admission (30.7% vs. 20.4-27.3% in others), followed by atrial fibrillation/flutter and heart failure/valve disorders. In-hospital mortality was higher in hematological cancer patients, especially for chronic ischemic heart disease (aOR 2.35, 95% CI 1.90-2.91, p<0.001). Within hematological cancers, acute hemorrhagic stroke had the highest mortality, particularly in leukemia (28.7% vs. 25.3-26.5%, p<0.001). Patients with hematological cancers admitted with a CV cause exhibit distinct patterns of CV admission causes, with hypertension, atrial fibrillation, and heart failure being the most common, and experience higher mortality than non-cancer patients during CV admissions. • Patients with hematological malignancies admitted with a cardiovascular cause demonstrate a distinct cardiovascular risk profile compared to non-malignant and other malignancies population. They present with advanced age, higher prevalence of atrial fibrillation, anemia, and thrombocytopenia, and have unique CV admission causes, including hypertension, atrial fibrillation/flutter, and heart failure/valve disorders, highlighting the intersection of hematological disease, cancer therapies, and cardiovascular pathophysiology. • The study underscores a higher in-hospital mortality for patients with hematological cancers, especially in cases of chronic ischemic heart disease and hemorrhagic stroke, compared to non-cancer patients. These outcomes emphasize the compounding risks posed by underlying malignancy-related coagulation imbalances and treatment-associated cardiotoxicity, which amplify the severity of CV events. • The findings advocate for integrative cardio-oncology care involving early identification, targeted management of CV comorbidities, and routine monitoring. Tailored strategies to mitigate cardiotoxic effects of cancer treatments are imperative to improving outcomes in this vulnerable population. The manuscript serves as a foundation for developing protocols that address the interplay between hematological malignancies and cardiovascular health.