Patients with cancer and cardiovascular disease may have a potentially higher risk of contracting COVID-19 and a higher likelihood of experiencing adverse outcomes from the disease, according to a paper published March 20 in JACC: CardioOncology.

Sarju Ganatra, MD, et al., reviewed preliminary data from China to assess the effects of COVID-19 in patients with pre-existing cancer and cardiovascular disease. The authors looked at COVID-19 outcomes in cancer and cardiovascular disease patients; acute cardiovascular injury and mechanism of injury; and management of cancer and cardiovascular disease patients with COVID-19, as well as those without COVID-19 in high-transmission areas; and future directions for management.

According to reports from China, about 1% of patients with confirmed COVID-19 had cancer, and 40% of COVID-19 patients who were hospitalized with pneumonia had pre-existing cardiovascular disease. Those with a history of cancer were more likely to develop severe disease, either requiring admission to an intensive care unit or resulting in death, compared to those without a cancer history (39% vs. 8%). Among cancer patients who had recently received chemotherapy or had surgery, 75% developed severe COVID-19, compared to 43% among those not recently treated for cancer. Early reports from China suggest the COVID-19 mortality rate was 5.6% among cancer patients and 13.2% among patients with cardiovascular disease, compared with about 1% in those without pre-existing cancer or cardiovascular disease.

The analysis also showed that many COVID-19 patients experienced acute myocardial injury, with 23% of patients developing heart failure. The mechanism for cardiovascular injury in COVID-19 patients is not yet well understood, but research suggests angiotensin-converting enzyme 2 (ACE-2) may play a role because it is expressed in lungs and cardiovascular system.

In terms of management of COVID-19 in patients with cancer and cardiovascular disease, the authors state there is no evidence to support widespread use of cardiac biomarker or echocardiographic monitoring, but note that these might be appropriate in high-risk patients with pre-existing cardiovascular disease, a history of exposure to cardiotoxic antineoplastic therapy, and either significant cardiovascular symptoms or lack of improvement with usual care. In areas with high COVID-19 transmission, there is no current guidance suggesting a need to delay cancer treatment; however, it may be reasonable for patients undergoing cancer treatment or who have had a recent stem cell transplant to self-quarantine.

According to the authors, the COVID-19 pandemic has shown that patients with cancer and cardiovascular disease are "particularly vulnerable," with an increased risk of contracting the virus and a higher likelihood of having severe disease and adverse outcomes. The cardiovascular community should "pay close attention to this growing patient population, particularly in such times of increased susceptibility," they conclude.

Clinical Topics: Cardio-Oncology, COVID-19 Hub, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Acute Heart Failure, Echocardiography/Ultrasound

Keywords: Cardiovascular Diseases, Quarantine, Pandemics, COVID-19, Coronavirus, Coronavirus Infections, Severe Acute Respiratory Syndrome, Cardiotoxicity, Peptidyl-Dipeptidase A, Heart Failure, Hematopoietic Stem Cell Transplantation, Pneumonia, Cardiovascular System, Echocardiography, Antineoplastic Agents, ACC International

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