Outcomes of patients with active cancers and pre-existing cardiovascular diseases infected with SARS-CoV-2
Authors: Patel Brijesh , Chapman Scott A. , Neumann Jake T. , Visaria Aayush , Ogungbe Oluwabunmi , Wen Sijin , Khodaverdi Maryam , Makwana Priyal , Singh Jasvinder A. , Sokos George ,   on behalf of the N3C Consortium, Wilcox Adam B. , Lee Adam M. , Graves Alexis , Anzalone Alfred Jerrod , Manna Amin , Saha Amit , Olex Amy , Zhou Andrea , Williams Andrew E. , Southerland Andrew , Girvin Andrew T. , Walden Anita , Sharathkumar Anjali A. , Amor Benjamin , Bates Benjamin , Hendricks Brian , Alexander Caleb , Bramante Carolyn , Ward-Caviness Cavin , Madlock-Brown Charisse , Suver Christine , Chute Christopher , Dillon Christopher , Wu Chunlei , Schmitt Clare , Takemoto Cliff , Housman Dan , Gabriel Davera , Eichmann David A. , Mazzotti Diego , Brown Don , Boudreau Eilis , Hill Elaine , Zampino Elizabeth , Marti Emily Carlson , Pfaff Emily R. , French Evan , Koraishy Farrukh M. , Mariona Federico , Prior Fred , Martin Greg , Lehmann Harold , Spratt Heidi , Mehta Hemalkumar , Liu Hongfang , Sidky Hythem , Hayanga J. W. Awori , Pincavitch Jami , Clark Jaylyn , Harper Jeremy Richard , Islam Jessica , Ge Jin , Gagnier Joel , Saltz Joel H. , Saltz Joel , Loomba Johanna , Buse John , Mathew Jomol , Rutter Joni L. , McMurry Julie A. , Guinney Justin , Starren Justin , Crowley Karen , Bradwell Katie Rebecca , Walters Kellie M. , Wilkins Ken , Gersing Kenneth R. , Cato Kenrick Dwain , Murray Kimberly , Kostka Kristin , Northington Lavance , Pyles Lee Allan , Misquitta Leonie , Cottrell Lesley , Portilla Lili , Deacy Mariam , Bissell Mark M. , Clark Marshall , Emmett Mary , Saltz Mary Morrison , Palchuk Matvey B. , Haendel Melissa A. , Adams Meredith , Temple-O’Connor Meredith , Kurilla Michael G. , Morris Michele , Qureshi Nabeel , Safdar Nasia , Garbarini Nicole , Sharafeldin Noha , Sadan Ofer , Francis Patricia A. , Burgoon Penny Wung , Robinson Peter , Payne Philip R. O. , Fuentes Rafael , Jawa Randeep , Erwin-Cohen Rebecca , Patel Rena , Moffitt Richard A. , Zhu Richard L. , Kamaleswaran Rishi , Hurley Robert , Miller Robert T. , Pyarajan Saiju , Michael Sam G. , Bozzette Samuel , Mallipattu Sandeep , Vedula Satyanarayana , O’Neil Shawn T. , Setoguchi Soko , Hong Stephanie S. , Johnson Steve , Bennett Tellen D. , Callahan Tiffany , Topaloglu Umit , Sheikh Usman , Gordon Valery , Subbian Vignesh , Kibbe Warren A. , Hernandez Wenndy , Beasley Will , Cooper Will , Hillegass William , Zhang Xiaohan Tanner 
Published: October 2023

Abstract
Objective
To determine the impact of acute SARS-CoV-2 infection on patient with concomitant active cancer and CVD.

Methods
The researchers extracted and analyzed data from the National COVID Cohort Collaborative (N3C) database between January 1, 2020, and July 22, 2022. They included only patients with acute SARS-CoV-2 infection, defined as a positive test by PCR 21 days before and 5 days after the day of index hospitalization. Active cancers were defined as last cancer drug administered within 30 days of index admission. The “Cardioonc” group consisted of patients with CVD and active cancers. The cohort was divided into four groups: (1) CVD (-), (2) CVD ( +), (3) Cardioonc (-), and (4) Cardioonc ( +), where (-) or ( +) denotes acute SARS-CoV-2 infection status. The primary outcome of the study was major adverse cardiovascular events (MACE), including acute stroke, acute heart failure, myocardial infarction, or all-cause mortality. The researchers analyzed the outcomes by different phases of the pandemic and performed competing-risk analysis for other MACE components and death as a competing event.

Results
The study analyzed 418,306 patients, of which 74%, 10%, 15.7%, and 0.3% had CVD (-), CVD ( +), Cardioonc (-), and Cardioonc ( +), respectively. The Cardioonc ( +) group had the highest MACE events in all four phases of the pandemic. Compared to CVD (-), the Cardioonc ( +) group had an odds ratio of 1.66 for MACE. However, during the Omicron era, there was a statistically significant increased risk for MACE in the Cardioonc ( +) group compared to CVD (-). Competing risk analysis showed that all-cause mortality was significantly higher in the Cardioonc ( +) group and limited other MACE events from occurring. When the researchers identified specific cancer types, patients with colon cancer had higher MACE.

Conclusion
In conclusion, the study found that patients with both CVD and active cancer suffered relatively worse outcomes when they had acute SARS-CoV-2 infection during early and alpha surges in the United States. These findings highlight the need for improved management strategies and further research to better understand the impact of the virus on vulnerable populations during the COVID-19 pandemic.