Impact of prior malignancy on cardiac complications and mortality in patients with COVID-19.

12109 Background: Cancer accounts for approximately 600,000 deaths annually in the United States, and patients with cancer are estimated to have nearly twice the risk of death following COVID-19 infection. While active malignancy and cancer-directed therapies are known to increase the risk of cardiac complications, it remains unclear whether patients with a prior history of cancer remain at elevated risk for cardiac events or mortality after COVID-19. This study aimed to evaluate whether a prior history of malignancy is associated with increased cardiac complications or all-cause mortality among Veterans diagnosed with COVID-19. We hypothesized that Veterans with a history of malignancy would have higher rates of cardiac complications and mortality following COVID-19 infection. Methods: We conducted a prospective observational cohort study of Veterans diagnosed with COVID-19 at the South Texas Veterans Health Care Center in San Antonio, Texas, using REDCap electronic data capture. Index dates ranged from March 13, 2020, through December 31, 2021, with a 10-month follow-up period. Both inpatient and outpatient Veterans were included. Patients with active malignancy or missing post-COVID cardiac outcome data were excluded. Patients were stratified into two groups: those with a prior history of malignancy and those without. The primary outcome was a composite of acute cardiac complications (arrhythmia, myocarditis, viral pericarditis, or viral cardiomyopathy) and all-cause mortality at 30 and 365 days. Results: Among 2,042 patients identified, 90 with active malignancy were excluded, leaving 1,952 patients for analysis. Of these, 5.3% (n=103) had a prior history of malignancy and 94.7% (n=1,849) had no malignancy history. Significant differences were observed in age, race, and BMI between groups. The composite primary outcome occurred more frequently in patients with prior malignancy at both 30 days (50% vs. 26%; OR 2.87, 95% CI 1.92–4.28, p<0.0001) and 365 days (53% vs. 29%; OR 3.06, 95% CI 2.05–4.58, p<0.0001). All-cause mortality was higher among patients with prior malignancy at 30 days (16% vs. 7%; OR 2.51, 95% CI 1.43–4.42, p=0.0013) and 365 days (16% vs. 14%; OR 3.03, 95% CI 1.97–4.66, p<0.0001). Cardiac complications alone were also more common in patients with prior malignancy (41% vs. 23%; OR 2.41, 95% CI 1.60–3.62, p<0.0001). Conclusions: In this large Veteran cohort, patients with a prior history of malignancy were approximately three times more likely to experience cardiac complications or death following COVID-19 infection compared with patients without a cancer history. These findings suggest that increased risk extends beyond active malignancy and highlight the need for targeted strategies to reduce adverse cardiac outcomes in patients with any history of cancer who develop COVID-19.