The University of Arkansas for Medical Sciences, Little Rock, AR
Arya Mariam Roy , Akshay Goel , Manojna Konda , Rashmi Verma
Background: Cardiotoxicity resulting in heart failure (HF) is one of the most common complications of chemotherapy which significantly impacts patient care and results in poor clinical outcomes. Based on prior clinical studies, cancer patients have multiple cardiovascular comorbidities and higher prevalence of cardiovascular diseases which makes them more vulnerable to cardiovascular injuries during chemotherapy. It may increase their risk of developing cardiomyopathy or worsening of the already existing cardiac conditions which result in HF and death. Methods: We conducted a retrospective analysis of the National Inpatient Sample Database for the year 2017. Patients who were admitted in the hospital for chemotherapy administration and those who have HF were identified using ICD-10 codes. The mortality of patients with HF who receive chemotherapy and the factors affecting the mortality were studied. The two groups that were studied are chemotherapy patients with and without HF. Results: A total of 29,018 admissions for chemotherapy were identified during the year 2017. Out of these, 2.64% of patients were found to have HF (n = 767). The median age for the patients who have an associated diagnosis of HF was 63. The overall mortality of chemotherapy-related admission was 0.80%. The mortality of patients with HF who received chemotherapy was higher than the patients without HF who received chemotherapy (4.3% vs 0.7%, OR = 1.82, p = 0.001). Patients with HF who were admitted for chemotherapy were 82% more likely to die while in hospital than those without HF. Females who have HF had a higher mortality rate and had 64% more odds of dying while admitted for chemotherapy than males with HF (7.92% vs 1.93%, OR = 1.64, P = 0.00, CI = 1.31- 1.82). Also, interestingly Asians who have HF had higher mortality while admitted for chemotherapy than all the other races who had HF who received chemotherapy (Asians vs Caucasians vs African Americans 13.63% vs 4.64% vs 2.85%, p = 0.041). Conclusions: The mortality of patients with heart failure who receives chemotherapy is higher than the overall mortality from chemotherapy-related side effects. Females and Asians who have HF had higher mortality while admitted for chemotherapy. Patients who have prior cardiovascular diseases have to be given diligent care and special attention while we plan for chemotherapy to prevent the development or worsening of heart failure.
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