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Cancer patients have worse outcomes and undergo fewer procedures following in-hospital cardiac than patients without comorbid cancer

Session Cardiovascular events in malignancies: from prediction to prevention

Speaker Benjamin Buck

Congress : ESC Congress 2018

  • Topic : cardiovascular disease in special populations
  • Sub-topic : Cardio-Oncology
  • Session type : Rapid Fire Abstracts
  • FP Number : 6137

Authors : B Buck (Columbus,US), A Guha (Columbus,US), S Arora (Chapel Hill,US), F Awan (Columbus,US), JC Lopez-Mattei (Houston,US), JC Plana Gomez (Houston,US), G Oliveira (Cleveland,US), M Fradley (Tampa,US), D Addison (Columbus,US)

Authors:
B. Buck1 , A. Guha2 , S. Arora3 , F. Awan4 , J.C. Lopez-Mattei5 , J.C. Plana Gomez6 , G. Oliveira7 , M. Fradley8 , D. Addison2 , 1The Ohio State University, Department of Internal Medicine - Columbus - United States of America , 2The Ohio State University, Internal Medicine, Division of Cardiovascular Medicine - Columbus - United States of America , 3University of North Carolina Hospitals, Department of Internal Medicine, Division of Cardiovascular Medicine - Chapel Hill - United States of America , 4The Ohio State University, Department of Internal Medicine, Division of Hematology - Columbus - United States of America , 5University of Texas MD Anderson Cancer Center, Department of Cardiology, Division of Internal Medicine - Houston - United States of America , 6Texas Heart Institute, Medicine-Cardiology - Houston - United States of America , 7University Hospitals Case Medical Center, Cardiology - Cleveland - United States of America , 8University of South Florida, Cardiology - Tampa - United States of America ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 1272-1273

Background: Cancer is tied to a high risk of incident cardiovascular disease (CVD). In broad populations survival to hospital discharge following in-hospital cardiac arrest (IHCA) has improved over the last decade but whether this extends to cancer patients remains unknown.

Purpose: To determine the contemporary incidence, trends, peri-IHCA procedural utilization, and survival of IHCA events among cancer patients, and compare these rates to the general population without cancer.

Methods: From the U.S. National Inpatient Sample database, we queried all hospitalizations from 2003–14 for all patients ≥18 years old with an in-hospital (and not presentation) diagnosis of cardiac arrest. Procedures, including cardiopulmonary resuscitation (CPR) were identified by ICD-9 procedure codes; cancers and other comorbidities (including atrial fibrillation, congestive heart failure, prior coronary artery disease, and hypertension) were identified by ICD-9 diagnosis codes and Charlton comorbidity scores were computed. Rates of IHCA, CPR utilization, peri-IHCA procedural utilization, and in-hospital survival were compared between patients with and without cancer.

Results: Over the 12 years considered, we identified 87,287 IHCAs during hospitalizations of patients with cancer, out of a total of 1,144,755 IHCA events. The primary admission diagnosis was acute syndrome in 6.9%, heart failure and cardiogenic shock in 2.7%, sepsis and septic shock in 0.05%, PE in 2.5%, ischemic stroke in 1.0% and hemorrhagic stroke in 1.0%; IHCA cancer patients were older, more likely female, but had less CVD cormorbities (table). The incidence of IHCA increased in both groups over this period with a greater increase in the cancer patients (p=0.049; figure). In-hospital survival after CPR in the hospitalizations of cancer patients who sustained IHCA was 22.1% compared to 46.4% in the population at large (p<0.0001; figure) and the utilization of peri-IHCA procedures was lower among those with cancer.

Conclusions: Over the last decade the incidence of U.S. IHCAs has increased. However, the diagnosis of cancer is associated with more frequent IHCA events, lower peri-IHCA procedural utilization rates, and lower survival to discharge.

IHCA incidence and survival

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