Among cancer patients treated with immune checkpoint inhibitors, cardiovascular hospital admission was associated with higher subsequent mortality (HR 3.29; 95% CI 2.70-4.02; P<0.001).
Cohort (n=1,080)
What are the risk factors for cardiovascular hospitalisations and all-cause mortality in cancer patients treated with immune checkpoint inhibitors?
In cancer patients treated with immune checkpoint inhibitors, pre-existing cardiovascular disease significantly increases the risk of cardiovascular hospitalizations, which is strongly associated with subsequent all-cause mortality.
Hazard Ratio: 3.29 (95% CI 2.7–4.02)
p-value: p=<0.001
Abstract Purpose Immune checkpoint inhibitors (ICIs) are highly effective cancer therapies. However, they are associated with considerable adverse cardiovascular (CV) outcomes. We investigated the risk factors for CV hospitalisations and all-cause mortality in oncology patients receiving ICIs. Methods A retrospective cohort study of adult patients administered ICIs between 1st January 2010 and 1st January 2020 in New South Wales, Australia. Electronic medical records were accessed to obtain demographic and clinical data. Univariate analysis included Chi-squared test for categorical variables and Student’s t -test for continuous variables. Binary logistic regression was used for multivariate analysis. Mortality was analysed using Cox regression including (i) time-dependent Cox models with CV admission as a time-varying covariate and (ii) a 1-year landmark sensitivity analysis. Results Out of 1,080 patients receiving ICIs during the study period, 340 patients (31.5%) had at least one CV hospital admission, and 763 patients (70.6%) had died by the end of the follow-up period. On multivariable analysis, prior history of heart failure and/or cardiomyopathy ( p < 0.001), arrhythmia ( p < 0.001) and ischaemic heart disease ( p < 0.001) were independently associated with an increased risk of CV hospital admission by approximately fourfold, while CV hospitalisation during follow-up ( p < 0.001) was independently associated with an increased risk of all-cause mortality. In a time-dependent Cox model ( n = 928; excluding CV admissions with missing admission timing), CV admission was associated with higher subsequent mortality (HR 3.29 95% CI 2.70–4.02; p < 0.001). In a 1-year landmark sensitivity analysis among patients alive at 365 days ( n = 533), CV admission within 1 year was associated with higher subsequent mortality (HR 2.36 95% CI 1.61–3.45; p < 0.001). Conclusion In cancer patients treated with ICIs, pre-existing CV risk factors significantly increase the risk of CV hospitalisations and all-cause mortality. Appropriate CV risk monitoring and management should be considered for people with cancer receiving ICI therapy.
Bennetts et al. (Thu,) conducted a cohort in Cancer (n=1,080). Cardiovascular hospital admission vs. No cardiovascular hospital admission was evaluated on All-cause mortality (HR 3.29, 95% CI 2.70-4.02, p=<0.001). Among cancer patients treated with immune checkpoint inhibitors, cardiovascular hospital admission was associated with higher subsequent mortality (HR 3.29; 95% CI 2.70-4.02; P<0.001).