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Background: The use of cannabis has massively increased among younger patients due to increasing legalization and availability., Methods: We performed a retrospective nationwide study using the Nationwide inpatient sample (NIS) database to analyze the trends of acute myocardial infarction (AMI) in young cannabis users and related outcomes among patients aged 18-49 years from 2007 to 2018, using ICD-9 and ICD-10 codes., Results: Out of 819,175 hospitalizations, 230,497 (28%) admissions reported using cannabis. There was a significantly higher number of males (78.08% vs. 71.58%, p < 0.0001) and African Americans (32.22% vs. 14.06%, p < 0.0001) admitted with AMI and reported cannabis use. The incidence of AMI among cannabis users consistently increased from 2.36% in 2007 to 6.55% in 2018. Similarly, the risk of AMI in cannabis users among all races increased, with the biggest increase in African Americans from 5.69% to 12.25%. In addition, the rate of AMI in cannabis users among both sexes showed an upward trend, from 2.63% to 7.17% in males and 1.62%-5.12% in females., Conclusion: The incidence of AMI in young cannabis users has increased in recent years. The risk is higher among males and African Americans., (© 2023 The Authors.)

T-cell therapies, such as chimeric antigen receptor (CAR) T-cell, bispecific T-cell engager (BiTE) and tumor-infiltrating lymphocyte (TIL) therapies, fight cancer cells harboring specific tumor antigens. However, activation of the immune response by these therapies can lead to a systemic inflammatory response, termed cytokine release syndrome (CRS), that can result in adverse events, including cardiotoxicity. Retrospective studies have shown that cardiovascular complications occur in 10% to 20% of patients who develop high-grade CRS after CAR T-cell therapy and can include cardiomyopathy, heart failure, arrhythmias, and myocardial infarction. While cardiotoxicities have been less commonly reported with BiTE and TIL therapies, systematic surveillance for cardiotoxicity has not been performed. Patients undergoing T-cell therapies should be screened for cardiovascular conditions that may not be able to withstand the hemodynamic perturbations imposed by CRS. Generalized management of CRS, including the use of the interleukin-6 antagonist, tocilizumab, for high-grade CRS, is used to mitigate the risk of cardiotoxicity., Competing Interests: Dr Nohria is supported by the Catherine Fitch Fund and the Gelb Master Clinician Fund at Brigham and Women’s Hospital; and is a consultant for AstraZeneca, Boehringer Ingelheim, Bantam Pharmaceuticals, and Takeda Oncology. Dr Zaha has received support from the Cancer Prevention Research Institute of Texas (RP180404). Dr Yang has received research funding from CSL Behring, Boehringer Ingelheim, and Eli Lilly; and has received consulting fees from Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)

Purpose: In PARADIGM-HF, sacubitril/valsartan showed a significant reduction in mortality and hospitalization for patients with heart failure with reduced ejection fraction. Despite proven efficacy, sacubitril/valsartan has moderate uptake in clinical practice. This study explores the safety profile of sacubitril/valsartan by comparing adverse events in RCT and real-world use., Methods: We studied hypotension, renal dysfunction, hyperkalemia, and angioedema associated with sacubitril/valsartan in RCTs and pharmacovigilance databases. A random-effects meta-analysis was performed with six RCTs investigating sacubitril/valsartan vs. control/comparators in heart failure patients. WHO's VigiBase, FAERS, and EMA's EudraVigilance were mined to obtain spontaneously reported real-world adverse events. Disproportionality analysis was performed with the FDA's OpenVigil 2.0., Results: Six RCTs enrolled 15,538 patients with heart failure with reduced and preserved ejection fractions. There was no statistical difference for the composite of hypotension, renal dysfunction, hyperkalemia, and angioedema between sacubitril/valsartan and its comparators viz. ACEi or ARBs (OR 1.23, CI 0.98-1.56; p = 0.08). A total of 103,038 adverse events were registered in the spontaneous reporting systems. Hypotension was the most reported adverse event. Proportions of composite adverse events were 20% in VigiBase, 17% in FAERS, and 39% with EudraVigilance. Disproportionality analysis showed a lower risk of adverse events with sacubitril/valsartan than other guideline-directed heart failure medications used in clinical practice., Conclusion: With increased uptake of sacubitril/valsartan, risks of hypotension, renal dysfunction, hyperkalemia, and angioedema appear low and acceptable in RCTs and global clinical practice., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Racial and social disparities exist in outcomes related to cancer and cardiovascular disease (CVD)., Objectives: The aim of this cross-sectional study was to study the impact of social vulnerability on mortality attributed to comorbid cancer and CVD., Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (2015-2019) was used to obtain county-level mortality data attributed to cancer, CVD, and comorbid cancer and CVD. County-level social vulnerability index (SVI) data (2014-2018) were obtained from the CDC's Agency for Toxic Substances and Disease Registry. SVI percentiles were generated for each county and aggregated to form SVI quartiles. Age-adjusted mortality rates (AAMRs) were estimated and compared across SVI quartiles to assess the impact of social vulnerability on mortality related to cancer, CVD, and comorbid cancer and CVD., Results: The AAMR for comorbid cancer and CVD was 47.75 (95% CI: 47.66-47.85) per 100,000 person-years, with higher mortality in counties with greater social vulnerability. AAMRs for cancer and CVD were also significantly greater in counties with the highest SVIs. However, the proportional increase in mortality between the highest and lowest SVI counties was greater for comorbid cancer and CVD than for either cancer or CVD alone. Adults <45 years of age, women, Asian and Pacific Islanders, and Hispanics had the highest relative increase in comorbid cancer and CVD mortality between the fourth and first SVI quartiles, without significant urban-rural differences., Conclusions: Comorbid cancer and CVD mortality increased in counties with higher social vulnerability. Improved education, resource allocation, and targeted public health interventions are needed to address inequities in cardio-oncology., Competing Interests: Dr Gupta is supported in part by National Institutes of Health/National Cancer Institute grant P30CA008748. Dr Nohria is supported by the Catherine Fitch Fund and the Gelb Master Clinician Fund at Brigham and Women’s Hospital. All authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)

Purpose of Review: The purpose of this article is to provide a comprehensive review of available data on health disparities and the interconnected social determinants of health (SDOH) in cardio-oncology. We identify the gaps in the literature and suggest areas for future research. In addition, we propose strategies to address these disparities at various levels., Recent Findings: There has been increasing recognition of health disparities and the role of SODH on an individual's access to health care, quality of care, and outcomes of the illness. There is growing evidence of sex and race-based differences in cancer therapy-related cardiotoxicity. Recent studies have shown how access and quality of health care are affected by financial stability and rurality. Our recent study utilizing the social vulnerability index (SVI) and county-level patient data found graded increase in county-level cardio-oncology mortality with greater social vulnerability. The incremental impact of social vulnerability was higher for cardio-oncology mortality than for mortality related to either cancer or CVD alone. The mortality rates in these patients were higher in rural areas compared to urban areas regardless of social vulnerability. Additionally, for those within the counties within highest social vulnerability, Black individuals had significantly higher cardio-oncology mortality compared with White individuals. Disparities in the cardio-oncology population are deep-rooted and widespread, leading to poor quality of life and increased mortality. It is crucial to integrate SDOH, not only in clinical care delivery but also in future research, and registry data to improve our understanding and the outcomes in our unique subset of cardio-oncology patients., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Patients with cancer have been shown to have increased risk of COVID-19 severity. We previously built and validated the COVID-19 Risk in Oncology Evaluation Tool (CORONET) to predict the likely severity of COVID-19 in patients with active cancer who present to hospital. We assessed the differences in presentation and outcomes of patients with cancer and COVID-19, depending on the wave of the pandemic. We examined differences in features at presentation and outcomes in patients worldwide, depending on the waves of the pandemic: wave 1 D614G (n = 1430), wave 2 Alpha (n = 475), and wave 4 Omicron variant (n = 63, UK and Spain only). The performance of CORONET was evaluated on 258, 48, and 54 patients for each wave, respectively. We found that mortality rates were reduced in subsequent waves. The majority of patients were vaccinated in wave 4, and 94% were treated with steroids if they required oxygen. The stages of cancer and the median ages of patients significantly differed, but features associated with worse COVID-19 outcomes remained predictive and did not differ between waves. The CORONET tool performed well in all waves, with scores in an area under the curve (AUC) of >0.72. We concluded that patients with cancer who present to hospital with COVID-19 have similar features of severity, which remain discriminatory despite differences in variants and vaccination status. Survival improved following the first wave of the pandemic, which may be associated with vaccination and the increased steroid use in those patients requiring oxygen. The CORONET model demonstrated good performance, independent of the SARS-CoV-2 variants.

Purpose of Review: Focused review highlighting select studies presented at the 2022 American College of Cardiology (ACC) Scientific Sessions., Recent Findings: Included studies assessed the impact of a low-sodium diet on heart failure outcomes (SODIUM-HF); outcomes of pregnant patients with chronic hypertension treated with antihypertensive therapies (CHAP); cardiovascular outcomes in patients with type 2 diabetes and renal impairment treated with sotagliflozin (SCORED); a safety and efficacy study investigating SLN360, a short interfering RNA targeting lipoprotein(a) (APOLLO); a supermarket and web-based intervention targeting nutrition for cardiovascular risk reduction (SuperWIN); a superiority trial comparing myocardial injury following very mild perioperative hypothermia versus aggressive warming after non-cardiac surgery (PROTECT); and 3-year efficacy outcomes of renal denervation on blood pressure reduction from the SPYRAL HTN-ON MED pilot study. Research presented at the 2022 ACC Scientific Sessions underscores the new potential and meaningful impact of cardiovascular disease prevention and management interventions., (© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Purpose: Patients with cancer are at increased risk of severe COVID-19 disease, but have heterogeneous presentations and outcomes. Decision-making tools for hospital admission, severity prediction, and increased monitoring for early intervention are critical. We sought to identify features of COVID-19 disease in patients with cancer predicting severe disease and build a decision support online tool, COVID-19 Risk in Oncology Evaluation Tool (CORONET)., Methods: Patients with active cancer (stage I-IV) and laboratory-confirmed COVID-19 disease presenting to hospitals worldwide were included. Discharge (within 24 hours), admission (≥ 24 hours inpatient), oxygen (O 2 ) requirement, and death were combined in a 0-3 point severity scale. Association of features with outcomes were investigated using Lasso regression and Random Forest combined with Shapley Additive Explanations. The CORONET model was then examined in the entire cohort to build an online CORONET decision support tool. Admission and severe disease thresholds were established through pragmatically defined cost functions. Finally, the CORONET model was validated on an external cohort., Results: The model development data set comprised 920 patients, with median age 70 (range 5-99) years, 56% males, 44% females, and 81% solid versus 19% hematologic cancers. In derivation, Random Forest demonstrated superior performance over Lasso with lower mean squared error (0.801 v 0.807) and was selected for development. During validation (n = 282 patients), the performance of CORONET varied depending on the country cohort. CORONET cutoffs for admission and mortality of 1.0 and 2.3 were established. The CORONET decision support tool recommended admission for 95% of patients eventually requiring oxygen and 97% of those who died (94% and 98% in validation, respectively). The specificity for mortality prediction was 92% and 83% in derivation and validation, respectively. Shapley Additive Explanations revealed that National Early Warning Score 2, C-reactive protein, and albumin were the most important features contributing to COVID-19 severity prediction in patients with cancer at time of hospital presentation., Conclusion: CORONET, a decision support tool validated in health care systems worldwide, can aid admission decisions and predict COVID-19 severity in patients with cancer., Competing Interests: Rebecca J. LeeSpeakers' Bureau: AstraZenecaResearch Funding: Bristol Myers Squibb (Inst), AstraZeneca/MedImmune (Inst) Rohan ShottonHonoraria: ServierTravel, Accommodations, Expenses: Servier Laurence AlbigesConsulting or Advisory Role: Bristol Myers Squibb (Inst), Ipsen (Inst), Roche (Inst), Novartis (Inst), Pfizer (Inst), Astellas Pharma (Inst), Merck (Inst), MSD (Inst), AstraZeneca (Inst), Janssen (Inst), Eisai (Inst), Corvus Pharmaceuticals (Inst), Bellerophon Therapeutics (Inst)Research Funding: Bristol Myers Squibb (Inst)Travel, Accommodations, Expenses: BMS, MSD Dirk ArnoldEmployment: Asklepios KlinikenHonoraria: Bayer, Merck Serono, Roche/Genentech, Servier, Bristol Myers Squibb, Merck Sharp and Dome, AstraZeneca, Amgen, Boston Scientific, Pierre Fabre, IpsenConsulting or Advisory Role: Bayer, Merck Serono, Biocompatibles, Terumo, Bristol Myers Squibb, MSD Oncology, AstraZenecaResearch Funding: Roche/Genentech (Inst), Sanofi (Inst), Oncolytics (Inst)Travel, Accommodations, Expenses: Boston ScientificUncompensated Relationships: ESMO Council, ESMO Journals (Ann Oncol, ESMO Open), German Society for Hematology and Medical Oncology, German Cancer Society, European Organisation for Research and Treatment of Cancer (EORTC) Kathryn BanfillStock and Other Ownership Interests: Roche (I)Honoraria: AstraZeneca Mark BaxterHonoraria: IpsenTravel, Accommodations, Expenses: Ipsen Fabrice BarlesiHonoraria: Genentech/Roche, Pfizer, Pierre Fabre, AstraZeneca, Bristol Myers Squibb, Boehringer Ingelheim, Lilly, Novartis, Merck Serono, MSD Oncology, Takeda, Bayer, Seattle Genetics, Mirati TherapeuticsConsulting or Advisory Role: Roche/Genentech, Pfizer, Novartis, Pierre Fabre, Bristol Myers Squibb, AstraZeneca/MedImmune, Boehringer Ingelheim, Lilly, Merck Serono, MSD Oncology, Takeda, Bayer, Mirati TherapeuticsResearch Funding: Roche/Genentech (Inst), AstraZeneca/MedImmune (Inst), Bristol Myers Squibb (Inst), Pierre Fabre (Inst), AbbVie (Inst), Amgen (Inst), Bayer (Inst), Boehringer Ingelheim (Inst), Eisai (Inst), Lilly (Inst), Ipsen (Inst), Innate Pharma (Inst), Novartis (Inst), Merck Serono (Inst), MSD Oncology (Inst), Pfizer (Inst), Sanofi/Aventis (Inst), Takeda (Inst)Travel, Accommodations, Expenses: Roche/Genentech, Bristol Myers Squibb, AstraZeneca/MedImmune, MSD Oncology Benjamin BesseResearch Funding: AstraZeneca (Inst), Pfizer (Inst), Lilly (Inst), Onxeo (Inst), Inivata (Inst), AbbVie (Inst), Amgen (Inst), Blueprint Medicines (Inst), Celgene (Inst), GlaxoSmithKline (Inst), Sanofi (Inst), Takeda (Inst), Cristal Therapeutics (Inst), Daiichi Sankyo (Inst), Janssen Oncology (Inst), OSE Immunotherapeutics (Inst), BeiGene (Inst), Boehringer Ingelheim (Inst), Roche/Genentech (Inst), Tolero Pharmaceuticals (Inst), 4D Pharma (Inst), Aptitude Health (Inst), Cergentis (Inst), Chugai Pharma (Inst), Genzyme (Inst), Ipsen (Inst), Turning Point Therapeutics (Inst), Eisai (Inst) Antonio CallesHonoraria: AstraZeneca, Boehringer Ingelheim, Pfizer, Roche/Genentech, Lilly, Novartis, Merck Sharp & Dohme, Bristol Myers Squibb, Amgen, Bayer, Takeda, Sanofi/RegeneronConsulting or Advisory Role: Boehringer Ingelheim, Roche/Genentech, Lilly, Merck Sharp & Dohme, Novartis, Pfizer, Bristol Myers Squibb, Takeda, Igen Biotech, Sanofi/RegeneronResearch Funding: MSD Oncology Ellen CopsonHonoraria: Roche, Pfizer, AstraZeneca, Lilly, NovartisConsulting or Advisory Role: Lilly, NanoString Technologies, Pfizer, Sanofi/Aventis, RocheSpeakers' Bureau: Roche, Pfizer, AstraZeneca, Sanofi/AventisResearch Funding: SECA, AstraZeneca (Inst)Travel, Accommodations, Expenses: Roche, AstraZeneca Adina E. CroitoruConsulting or Advisory Role: Ipsen, Pfizer, MSD OncologyResearch Funding: Bristol Myers Squibb (Inst), Amgen (Inst), Astellas Pharma (Inst), Exelixis (Inst), Merck (Inst), Merck KGaA (Inst)Travel, Accommodations, Expenses: Merck, ServierUncompensated Relationships: Lilly, Roche, Bayer, Pfizer, Sanofi Leonie EastlakeTravel, Accommodations, Expenses: Servier Paul FitzpatrickStock and Other Ownership Interests: AstraZeneca/MedImmuneResearch Funding: AstraZeneca/MedImmune (Inst)Other Relationship: Pistoia Alliance, EHDEN IMI project Henrik FrederiksenResearch Funding: AbbVie (Inst), Gilead Sciences (Inst), Sanofi (Inst) Hannah FrostResearch Funding: AstraZeneca (Inst) Sarju GanatraExpert Testimony: Haymarket Medical EducationTravel, Accommodations, Expenses: Haymarket Medical Education Andreas GlenthøjHonoraria: Novo NordiskConsulting or Advisory Role: Novartis, Celgene/Bristol Myers Squibb, Bluebird Bio, Sanofi, Novo Nordisk, AgiosResearch Funding: Sanofi, Saniona A/STravel, Accommodations, Expenses: Agios Fabio GomesHonoraria: AstraZeneca, Merck Serono, Roche Donna M. GrahamConsulting or Advisory Role: Clinigen GroupSpeakers' Bureau: Cancer Drug Development ForumResearch Funding: Pfizer (Inst) Kevin HarringtonHonoraria: Arch Oncology (Inst), AstraZeneca (Inst), BMS (Inst), Boehringer Ingelheim (Inst), Merck Serono (Inst), MSD (Inst), Oncolys BioPharma (Inst), Pfizer (Inst), Replimune (Inst), Inzen Therapeutics (Inst), Codiak Biosciences (Inst)Consulting or Advisory Role: Arch Oncology (Inst), AstraZeneca (Inst), BMS (Inst), Boehringer Ingelheim (Inst), Merck Serono (Inst), MSD (Inst), Oncolys BioPharma (Inst), Replimune (Inst), Inzen Therapeutics (Inst)Speakers' Bureau: BMS (Inst), Merck Serono (Inst), MSD (Inst)Research Funding: AstraZeneca (Inst), Merck Sharp & Dohme (Inst), Replimune (Inst), Boehringer Ingelheim (Inst) Lasse H. JakobsenHonoraria: Takeda, Roche Khurum KhanHonoraria: ServierConsulting or Advisory Role: Bayer Health Christophe MassardConsulting or Advisory Role: Amgen, Astellas Pharma, AstraZeneca, Bayer, BeiGene, BMS, Celgene, Debiopharm Group, Genentech/Roche, Ipsen, Janssen, Lilly, MSD, Novartis, Pfizer, Sanofi, ORION, Taiho Pharmaceutical, Blueprint Medicines, Innate Pharma, PharmaMar, Faron Pharmaceuticals Olivier MichielinConsulting or Advisory Role: Bristol Myers Squibb, MSD, Novartis, Roche, Amgen, Pierre FabreResearch Funding: MSD, Bristol Myers Squibb, NeraCare GmbHExpert Testimony: Bristol Myers SquibbTravel, Accommodations, Expenses: Bristol Myers Squibb, MSD Anne C. MosenthalHonoraria: Springer Nature Berta ObispoHonoraria: Sanofi, Lilly, Angelini, LEO Pharma, RoviConsulting or Advisory Role: Rovi George PentheroudakisHonoraria: Roche, Amgen, Bristol Myers Squibb, MSD, MerckConsulting or Advisory Role: Roche, AmgenResearch Funding: Roche (Inst), Amgen (Inst), Bristol Myers Squibb (Inst), Merck (Inst), AstraZeneca (Inst), Novartis (Inst), Pfizer (Inst)Travel, Accommodations, Expenses: Sanofi, MSD, Roche, Amgen, BMS Solange PetersHonoraria: Roche (Inst), Bristol Myers Squibb (Inst), Novartis (Inst), Pfizer (Inst), MSD (Inst), AstraZeneca (Inst), Takeda (Inst), Illumina (Inst), Medscape (Inst), Prime Oncology (Inst), RMEI Medical Education (Inst), Research to Practice (Inst), PER (Inst), Imedex (Inst), ecancer (Inst)Consulting or Advisory Role: Roche/Genentech (Inst), Novartis (Inst), Bristol Myers Squibb (Inst), Pfizer (Inst), MSD (Inst), Amgen (Inst), AstraZeneca (Inst), Janssen (Inst), Regeneron (Inst), Merck Serono (Inst), Boehringer Ingelheim (Inst), Takeda (Inst), Lilly (Inst), AbbVie (Inst), Bayer (Inst), Biocartis (Inst), Debiopharm Group (Inst), Illumina (Inst), PharmaMar (Inst), Sanofi (Inst), Seattle Genetics (Inst), Blueprint Medicines (Inst), Daiichi Sankyo (Inst), Incyte (Inst), Bioinvent (Inst), Clovis Oncology (Inst), Vaccibody (Inst), Phosplatin Therapeutics (Inst), Foundation Medicine (Inst)Research Funding: Roche (Inst), BMS (Inst), MSD (Inst), Amgen (Inst), Lilly (Inst), AstraZeneca (Inst), Pfizer (Inst), Illumina (Inst), Merck Serono (Inst), Novartis (Inst), Biodesix (Inst), Boehringer Ingelheim (Inst), Iovance Biotherapeutics (Inst), Phosplatin Therapeutics (Inst)Travel, Accommodations, Expenses: Roche, Bristol Myers Squibb, MSD, Sanofi, IncyteUncompensated Relationships: Journal of Thoracic Oncology, ESMO, European Thoracic Oncology Platform (ETOP), Annals of Oncology (I) Kimberly Rieger-ChristResearch Funding: Veracyte, Ravel, Grail, Exact Sciences, Nucleix Timothy RobinsonTravel, Accommodations, Expenses: Daiichi Sankyo/Lilly Emanuela RomanoConsulting or Advisory Role: AstraZeneca/MedImmune (Inst), Bristol Myers Squibb (Inst), Roche/Genentech (Inst)Research Funding: Bristol Myers Squibb, AmgenTravel, Accommodations, Expenses: AstraZeneca/MedImmune, Bristol Myers Squibb, Roche Michael RoweHonoraria: MSDSpeakers' Bureau: ServierTravel, Accommodations, Expenses: Astellas Pharma Anne ThomasConsulting or Advisory Role: BMSSpeakers' Bureau: Bristol Myers SquibbExpert Testimony: BMS Lance TurtleSpeakers' Bureau: Eisai (Inst) David ViñalSpeakers' Bureau: ServierTravel, Accommodations, Expenses: Merck Caroline WilsonConsulting or Advisory Role: Roche, Pfizer Carlo PalmieriHonoraria: PfizerConsulting or Advisory Role: Pfizer, Daiichi-Sankyo, Lilly, Novartis, Seattle GeneticsResearch Funding: Pfizer, Daiichi-SankyoTravel, Accommodations, Expenses: Roche Donal LandersEmployment: AstraZeneca, AthenexLeadership: DeLondra OncologyStock and Other Ownership Interests: DeLondra OncologyResearch Funding: AstraZeneca (Inst) Timothy CooksleyHonoraria: Bristol Myers Squibb Foundation Caroline DiveConsulting or Advisory Role: Biocartis, Merck, AstraZeneca, GRAIL, Boehringer IngelheimResearch Funding: AstraZeneca, Astex Pharmaceuticals, Bioven, Amgen, Carrick Therapeutics, Merck, Taiho Oncology, GlaxoSmithKline, Bayer, Boehringer Ingelheim, Roche, BMS, Novartis, Celgene, Epigene Therapeutics, Angle, Menarini, Clearbridge Biomedics, Thermo Fisher Scientific, NeoMed André FreitasResearch Funding: AstraZeneca (Inst) Anne C. ArmstrongStock and Other Ownership Interests: AstraZeneca (I)Consulting or Advisory Role: Gilead Sciences, MSDResearch Funding: AstraZeneca/MedImmune (Inst)Travel, Accommodations, Expenses: Gilead Sciences, MSD OncologyNo other potential conflicts of interest were reported.

Background: The incidence of atrial fibrillation (AF) in patients with chronic lymphocytic leukemia (CLL) has been on the rise. However, the excess burden added by AF to the morbidity and mortality of CLL patients especially in the hospitalized setting is undetermined., Methods: The National Inpatient Sample (NIS) database was accessed to gather data of hospitalized CLL patients with AF from 2009 to 2018. Propensity-score matching (PSM) and logistic regression model were performed to control for baseline patient factors to match 7265 CLL patient admissions with AF and 7265 CLL patient admissions without AF. The primary outcome was all-cause mortality (ACM), while the secondary outcomes included acute coronary syndrome (ACS), acute myocardial infarction (AMI), and the need for percutaneous coronary intervention (PCI), acute heart failure (AHF), acute hypoxic respiratory failure (AHRF), cardiac arrest (CA), cardiogenic shock (CS), stroke, and the total cost of hospitalization., Results: CLL patients with AF had a higher rate of ACM (6.06% vs 4.47%; odds ratio [OR] 1.39, 95% confidence interval [CI] 1.19-1.61; P =< .001). All other secondary outcomes including ACS, AMI, PCI, AHRF, CA, CS, and stroke were observed at a significantly higher rate in the AF group as well. The median total hospital cost was also higher in the AF group ($9097 vs. $7646; P value < .0001) CONCLUSION: CLL patients with AF are at a significantly increased risk of all-cause mortality, cardiac-related mortality, and stroke. For this population, a multidisciplinary approach should be orchestrated for better management and outcomes., (Copyright © 2021. Published by Elsevier Inc.)

Purpose of Review: The COVID-19 pandemic has disrupted healthcare and has disproportionately affected the marginalized populations. Patients with cancer and cardiovascular disease (cardio-oncology population) are uniquely affected. In this review, we explore the current data on COVID-19 vulnerability and outcomes in these patients and discuss strategies for cardio-oncology care with a focus on healthcare innovation, health equity, and inclusion., Recent Findings: The growing evidence suggest increased morbidity and mortality from COVID-19 in patients with comorbid cancer and cardiovascular disease. Additionally, de novo cardiovascular complications such as myocarditis, myocardial infarction, arrhythmia, heart failure, and thromboembolic events have increasingly emerged, possibly due to an accentuated host immune response and cytokine release syndrome., Summary: Patient-centric policies are helpful for cardio-oncology surveillance like remote monitoring, increased use of biomarker-based surveillance, imaging modalities like CT scan, and point-of-care ultrasound to minimize the exposure for high-risk patients. Abundant prior experience in cancer therapy scaffolded the repurposed use of corticosteroids, IL-6 inhibitors, and Janus kinase inhibitors in the treatment of COVID-19 infection. COVID-19 vaccine timing and dose frequency present a challenge due to overlapping toxicities and immune cell depletion in patients receiving cancer therapies. The SARS-CoV-2 pandemic laid bare social and ethnic disparities in healthcare but also steered in innovation to combat problems of patient outreach, particularly with virtual care. In the recovery phase, the backlog in cardio-oncology care, interplay of cancer therapy-related side effects, and long COVID-19 syndrome are crucial issues to address., Competing Interests: Conflict of InterestSonu Abraham declares that she has no conflict of interest. Shamitha Alisa Manohar declares that she has no conflict of interest. Rushin Patel declares that he has no conflict of interest. Anu Mariam Saji declares that she has no conflict of interest. Sourbha S. Dani declares that he has no conflict of interest. Sarju Ganatra declares that he has no conflict of interest., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Purpose of Review: Immune checkpoint inhibitors (ICIs) have improved the survival of several cancers. However, they may cause a wide range of immune-related adverse events (irAEs). While most irAEs are manageable with temporary cessation of ICI and immunosuppression, cardiovascular toxicity can be associated with high rates of morbidity and mortality. As ICIs evolve to include high-risk patients with preexisting cardiovascular risk factors and disease, the risk and relevance of ICI-associated cardiotoxicity may be even higher., Recent Findings: Several cardiovascular toxicities such as myocarditis, stress cardiomyopathy, and pericardial disease have been reported in association with ICIs. Recent findings also suggest an increased risk of atherosclerosis with ICI use. ICI-associated myocarditis usually occurs early after initiation and can be fulminant. A high index of suspicion is required for timely diagnosis. Prompt treatment with high-dose corticosteroids is shown to improve outcomes. Although the overall incidence is rare, ICI cardiotoxicity, particularly myocarditis, is associated with significant morbidity and mortality, making it a major therapy-limiting adverse event. Early recognition and prompt treatment with the cessation of ICI therapy and initiation of high-dose corticosteroids are crucial to improve outcomes. Cardio-oncologists will need to play an important role not just in the management of acute cardiotoxicity but also to reduce the risk of long-term sequelae.

Background: AKI is a significant complication of coronavirus disease 2019 (COVID-19), with no effective therapy. Niacinamide, a vitamin B3 analogue, has some evidence of efficacy in non-COVID-19-related AKI. The objective of this study is to evaluate the association between niacinamide therapy and outcomes in patients with COVID-19-related AKI., Methods: We implemented a quasi-experimental design with nonrandom, prospective allocation of niacinamide in 201 hospitalized adult patients, excluding those with baseline eGFR <15 ml/min per 1.73 m 2 on or off dialysis, with COVID-19-related AKI by Kidney Disease Improving Global Outcomes (KDIGO) criteria, in two hospitals with identical COVID-19 care algorithms, one of which additionally implemented treatment with niacinamide for COVID-19-related AKI. Patients on the niacinamide protocol (B3 patients) were compared against patients at the same institution before protocol commencement and contemporaneous patients at the non-niacinamide hospital (collectively, non-B3 patients). The primary outcome was a composite of death or RRT., Results: A total of 38 out of 90 B3 patients and 62 out of 111 non-B3 patients died or received RRT. Using multivariable Cox proportional hazard modeling, niacinamide was associated with a lower risk of RRT or death (HR, 0.64; 95% CI, 0.40 to 1.00; P =0.05), an association driven by patients with KDIGO stage-2/3 AKI (HR, 0.29; 95% CI, 0.13 to 0.65; P =0.03; P interaction with KDIGO stage=0.03). Total mortality also followed this pattern (HR, 0.17; 95% CI, 0.05 to 0.52; in patients with KDIGO stage-2/3 AKI, P =0.002). Serum creatinine after AKI increased by 0.20 (SEM, 0.08) mg/dl per day among non-B3 patients with KDIGO stage-2/3 AKI, but was stable among comparable B3 patients (+0.01 [SEM, 0.06] mg/dl per day; P interaction=0.03)., Conclusions: Niacinamide was associated with lower risk of RRT/death and improved creatinine trajectory among patients with severe COVID-19-related AKI. Larger randomized studies are necessary to establish a causal relationship., Competing Interests: A. Asnani reports being a scientific advisor or members of Sarnoff Cardiovascular Research Foundation, and receiving honoraria from UpToDate. R.S. Brown received royalties from Börm Bruckmeier Publishing LLC for a book and two applications, Nephrology Pocket and Acid Base and Electrolytes, on smartphones, with the second edition of Nephrology Pocket to be published by Elsevier, Inc. In R.S. Brown’s role at Harvard Medical Faculty Physicians (HMFP) at Beth Israel Deaconess Medical Center, he serves as an associate medical director of DaVita Dialysis Center (Brookline, MA). All income paid by this facility goes directly to HMFP, from which he receives a fixed salary. He also reports receiving honoraria from Harvard Medical School Department of Continuing Education, Beth Israel Deaconess Medical Center; having ownership interest in Innovative Wellness Systems, Inc.; being a member of the medical advisory board of the National Kidney Foundation of New England; and being on the board of directors and president of The Organization for Renal Care in Haiti (TORCH) Inc., a nonprofit, charitable corporation in Massachusetts. No income is received from any of these entities. K. Mukamal reports having other interests/relationships with US Highbush Blueberry Council and Wolters Kluwer. S.M. Parikh is listed as an inventor on patent filings from Beth Israel Deaconess Medical Center related to NAD+. S.M. Parikh reports having consultancy agreements with Aerpio, Alkermes, Astellas, Cytokinetics, Hope Pharmaceuticals, Janssen, Leerink Swann, Mission Therapeutics, and Mitobridge; being a scientific advisor for or member of Aerpio, JASN, Kidney360, and Raksana; receiving consulting fees in the last 3 years from Alkermes, Astellas, Cytokinetics, Daiichi Sankyo, Janssen, and Mission Therapeutics; receiving honoraria from American Society of Nephrology; receiving research funding from Baxter; and having ownership interest in Eunoia and Raksana. Work in S.M. Parikh’s laboratory is supported by National Heart, Lung, and Blood Institute grant R35-HL139424, National Institute of Diabetes and Digestive and Kidney Diseases grant R01-DK095072, and National Institute on Aging grant R01-AG027002. A. Poyan Mehr reports receiving research funding from ASN Carl W. Gottschalk Research Scholar Grant (2018) and Retrophin; being the site principle investigator for the DUPLEX Study (a phase-3 randomized trial in primary FSGS); having industry-sponsored clinical trial agreements with OMEROS, Roche, and Vertex; being the director of the GlomCon Project, an initiative to enhance education about glomerular disorders. This project is collaborating closely with the NephCure Foundation, which has provided financial and in-kind support for a continuing medical education–accredited conference series focused on clinical trials. A. Poyan Mehr has additional educational collaborations with the Renal Pathology Society and the European Renal Association. A. Poyan Mehr’s employer does not permit serving on any speaker bureau, advisory board, perform consultancy, or receive industry honoraria. N.H. Raines reports being a scientific advisor for or member of La Isla Network. J. Schlondorff reports being a scientific advisor for or member of the Alport Syndrome Foundation Medical Advisory Committee and having patents and inventions with Partners Healthcare. T.I. Steinman reports being a reviewer for CJASN and a member of the editorial board for Nephrology News and Issues; receiving research funding from Kadmon, Reata, and Retrophin; receiving honoraria from Mallinkrodt and Otsuka; being on the medical advisory board for the National Kidney Foundation of Massachusetts, Rhode Island, New Hampshire, and Vermont; and having other interests/relationships with National Kidney Foundation and Polycystic Kidney Foundation. M.L. Zeidel reports being a scientific advisor for or member of the Beth Israel Deaconess Medical Center and Hebrew Senior Life. All remaining authors have nothing to disclose., (Copyright © 2021 by the American Society of Nephrology.)

Background: Cancer and cardiovascular disease (CVD) are independently associated with adverse outcomes in patients with COVID-19. However, outcomes in patients with COVID-19 with both cancer and comorbid CVD are unknown., Methods: This retrospective study included 2,476 patients who tested positive for SARS-CoV-2 at 4 Massachusetts hospitals between March 11 and May 21, 2020. Patients were stratified by a history of either cancer (n=195) or CVD (n=414) and subsequently by the presence of both cancer and CVD (n=82). We compared outcomes between patients with and without cancer and patients with both cancer and CVD compared with patients with either condition alone. The primary endpoint was COVID-19-associated severe disease, defined as a composite of the need for mechanical ventilation, shock, or death. Secondary endpoints included death, shock, need for mechanical ventilation, need for supplemental oxygen, arrhythmia, venous thromboembolism, encephalopathy, abnormal troponin level, and length of stay., Results: Multivariable analysis identified cancer as an independent predictor of COVID-19-associated severe disease among all infected patients. Patients with cancer were more likely to develop COVID-19-associated severe disease than were those without cancer (hazard ratio [HR], 2.02; 95% CI, 1.53-2.68; P<.001). Furthermore, patients with both cancer and CVD had a higher likelihood of COVID-19-associated severe disease compared with those with either cancer (HR, 1.86; 95% CI, 1.11-3.10; P=.02) or CVD (HR, 1.79; 95% CI, 1.21-2.66; P=.004) alone. Patients died more frequently if they had both cancer and CVD compared with either cancer (35% vs 17%; P=.004) or CVD (35% vs 21%; P=.009) alone. Arrhythmias and encephalopathy were also more frequent in patients with both cancer and CVD compared with those with cancer alone., Conclusions: Patients with a history of both cancer and CVD are at significantly higher risk of experiencing COVID-19-associated adverse outcomes. Aggressive public health measures are needed to mitigate the risks of COVID-19 infection in this vulnerable patient population.

Patients with pre-existing cardiovascular disease and risk factors are more likely to experience adverse outcomes associated with the novel coronavirus disease-2019 (COVID-19). Additionally, consistent reports of cardiac injury and de novo cardiac complications, including possible myocarditis, arrhythmia, and heart failure in patients without prior cardiovascular disease or significant risk factors, are emerging, possibly due to an accentuated host immune response and cytokine release syndrome. As the spread of the virus increases exponentially, many patients will require medical care either for COVID-19 related or traditional cardiovascular issues. While the COVID-19 pandemic is dominating the attention of the healthcare system, there is an unmet need for a standardized approach to deal with COVID-19 associated and other traditional cardiovascular issues during this period. We provide consensus guidance for the management of various cardiovascular conditions during the ongoing COVID-19 pandemic with the goal of providing the best care to all patients and minimizing the risk of exposure to frontline healthcare workers., (Copyright © 2020. Published by Elsevier Inc.)