Factors influencing the mortality risk of heart failure in patients receiving antineoplastic immunotherapy: A national inpatient database study 2016-2020.

person Purva Shah Rochester General Hospital, Rochester, NY info_outline Purva Shah, Abdullah Ahmad Orakzai, Himal Kharel, Aditya Sanjeevi, Basant Eltaher, Jose M. Easow

Authors person Purva Shah Rochester General Hospital, Rochester, NY info_outline Purva Shah, Abdullah Ahmad Orakzai, Himal Kharel, Aditya Sanjeevi, Basant Eltaher, Jose M. Easow Organizations Rochester General Hospital, Rochester, NY, Apollo Cancer Specialty Hospital, Chennai, Tamil Nadu, India Abstract Disclosures Research Funding No funding sources reported Background: Immunotherapy is increasingly being used for management of solid and lymphoproliferative tumors due to their more desirable side effect profile as compared to traditional cancer therapies. However, these medications are associated with cardiac complications and little is known about the factors influencing the prognosis in these patients. Methods: This is a retrospective analysis of the National Inpatient Database from 2016 to 2020 using the International Classification of Diseases (ICD) 10 codes performed with STATA BE 18.0. Chi square test was used for crude analysis and multivariate logistic regression was performed to assess the risk of inpatient death among cancer patients with heart failure receiving immunotherapy. Results were adjusted for potential confounders like age, gender, race, hypertension, diabetes, coronary artery disease, smoking, and alcohol consumption. Multicollinearity of the model was assessed using Variance Inflation Factor (VIF) post-estimation test. Results: Out of 5166 cancer patients receiving immunotherapy with a mean age of 43.63 土 26.33 years and 41% females, 45 patients had heart failure. Logistic regression showed that heart failure was significantly associated with mortality (LR 𝜒² 38.74, p value < 0.001) on adjusting for potential confounders. Although the effect size was small, increased age (OR 1.025, CI 1.01-1.04) had a significantly higher risk of mortality. Patients belonging to the female gender and white, hispanic, and asian races had a lower risk of mortality while those belonging to the african american race and those with coronary artery disease had a higher mortality risk, although not statistically significant. Diabetes and alcohol consumption had a fourfold and sixfold increased risk of mortality respectively. Hypertension and smoking that are known to increase mortality risk in heart failure patients showed a paradoxically protective effect in this cohort. Conclusions: This study highlights the importance of risk stratification and prognostication among patients with heart failure receiving antineoplastic immunotherapy. Increased age, african american race, diabetes, alcohol consumption, and coronary artery disease have shown an increased mortality risk in these patients. The effect of demographic factors and co-morbidities on inpatient death in cancer patients receiving immunotherapy who develop heart failure. Variable Odd Ratio P value 95% Confidence Interval Age 1.025 0.003 1.01-1.04 Females 0.61 0.14 0.32-1.17 White 0.76 0.714 0.18-3.26 African american 1.55 0.604 0.30-8.20 Hispanic 0.8 0.795 0.14-4.43 Asian 0.44 0.504 0.04-4.93 Diabetes 4.27 0.056 0.96-18.91 Hypertension 0.88 0.713 0.46-1.70 Coronary artery disease 1.1 0.862 0.37-3.28 Active smokers 0.81 0.579 0.37-1.73 Alcohol use 6.43 0.081 0.80-51.84