Symptoms at presentation and cardiovascular outcomes in patients accessing a tertiary oncological emergency department

Background The prevalence of acute cardiovascular diseases (CVDs) among cancer patients is steadily increasing, making it a significant cause for admission to the emergency department (ED). Methods We conducted a prospective observational study involving consecutive cancer patients presenting to a tertiary oncological ED. Patients were categorized into two groups based on the primary symptoms leading to their ED visit: symptoms potentially related to acute CVD and symptoms potentially unrelated to acute CVD. The study aimed to: (i) describe the prevalence of symptoms potentially related to acute CVD in the setting of an oncology-ED, (ii) evaluate the prevalence of confirmed CVD diagnoses at discharge, and (iii) identify potential predictors of confirmed CVD diagnoses at discharge. Results From November 2023 to December 2024, we enrolled 472 patients. Twelve patients (2.5%) who died on the day of ED admission were excluded from the analysis. Of the remaining 460 patients, 161 (35.0%) presented with symptoms potentially related to acute CVD. Baseline characteristics were comparable between the two groups, including age (65.9±13.3 vs. 66.4±13.0 years), female sex (54.2% vs. 49.1%), active malignancy (97.3% vs. 99.4%), and metastatic cancer (55.4% vs. 59.6%) (all p > 0.05). A total of 30 patients (6.5%) were discharged with a diagnosis of acute CVD. Among these, 15/161 (9.3%) presented with symptoms potentially related to acute CVD, while 15/299 (5.0%) did not. Multivariable regression analysis identified atrial fibrillation and ST-segment depression on admission ECG as independent predictors of an acute CVD diagnosis at discharge (OR 2.28; 95% CI 1.01–5.04, and OR 10.19; 95% CI 1.61–53.15, respectively). Neither comorbidities nor presenting symptoms were significant predictors. Furthermore, symptoms potentially related to acute CVD at admission showed low sensitivity (66%) and specificity (50%) for predicting a confirmed diagnosis of acute CVD. Conclusions In this contemporary cohort of cancer patients presenting to a tertiary oncological ED, symptoms potentially related to acute CVD were common. However, presenting symptoms were not reliably associated with confirmed CVD diagnoses at discharge, underscoring the importance of a multidisciplinary approach in evaluating this unique patient population.