Patients with both cancer and cardiovascular disease had a higher likelihood of COVID-19-associated severe disease compared with those with cancer alone (HR 1.86; 95% CI 1.11-3.10; P=0.02).
Cohort (n=2,476)
Yes
Does a history of both cancer and cardiovascular disease increase the risk of severe disease in patients with COVID-19?
Patients with COVID-19 and a history of both cancer and cardiovascular disease are at significantly higher risk for severe disease and death compared to those with either condition alone.
Effect estimate: HR 1.86 (95% CI 1.11-3.10)
p-value: p=0.02
BACKGROUND: Cancer and cardiovascular disease (CVD) are independently associated with adverse outcomes in patients with COVID-19. However, outcomes in patients with COVID-19 with both cancer and comorbid CVD are unknown. METHODS: This retrospective study included 2,476 patients who tested positive for SARS-CoV-2 at 4 Massachusetts hospitals between March 11 and May 21, 2020. Patients were stratified by a history of either cancer (n=195) or CVD (n=414) and subsequently by the presence of both cancer and CVD (n=82). We compared outcomes between patients with and without cancer and patients with both cancer and CVD compared with patients with either condition alone. The primary endpoint was COVID-19-associated severe disease, defined as a composite of the need for mechanical ventilation, shock, or death. Secondary endpoints included death, shock, need for mechanical ventilation, need for supplemental oxygen, arrhythmia, venous thromboembolism, encephalopathy, abnormal troponin level, and length of stay. RESULTS: Multivariable analysis identified cancer as an independent predictor of COVID-19-associated severe disease among all infected patients. Patients with cancer were more likely to develop COVID-19-associated severe disease than were those without cancer (hazard ratio HR, 2.02; 95% CI, 1.53-2.68; P<.001). Furthermore, patients with both cancer and CVD had a higher likelihood of COVID-19-associated severe disease compared with those with either cancer (HR, 1.86; 95% CI, 1.11-3.10; P=.02) or CVD (HR, 1.79; 95% CI, 1.21-2.66; P=.004) alone. Patients died more frequently if they had both cancer and CVD compared with either cancer (35% vs 17%; P=.004) or CVD (35% vs 21%; P=.009) alone. Arrhythmias and encephalopathy were also more frequent in patients with both cancer and CVD compared with those with cancer alone. CONCLUSIONS: Patients with a history of both cancer and CVD are at significantly higher risk of experiencing COVID-19-associated adverse outcomes. Aggressive public health measures are needed to mitigate the risks of COVID-19 infection in this vulnerable patient population.
Ganatra et al. (Mon,) conducted a cohort in COVID-19 (n=2,476). History of both cancer and cardiovascular disease vs. History of either cancer or cardiovascular disease alone was evaluated on COVID-19-associated severe disease (composite of mechanical ventilation, shock, or death) (HR 1.86, 95% CI 1.11-3.10, p=0.02). Patients with both cancer and cardiovascular disease had a higher likelihood of COVID-19-associated severe disease compared with those with cancer alone (HR 1.86; 95% CI 1.11-3.10; P=0.02).