The Association between Chronic Myeloid Leukemia and Heart Failure

Introduction

The first and second leading causes of death in the United States are heart disease and cancer respectively. Chronic myeloid leukemia (CML) is a hematopoietic stem cell malignancy diagnosed at the mean age of 66. The rate of cardiovascular diseases in CML have been increased with the advent of therapies such as tyrosine kinase inhibitors (TKIs) as well as the improved survival rate with the treatments. Heart failure is one the most commonly identified cancer-therapy related cardiovascular adverse events. In this study, we are using national population cohort to study the association between CML and heart failure.

Methods

We conducted a retrospective analysis of 3 years of National inpatient sample (HCUP-NIS) from 2016 to 2018 data base. Patient older than 60 years old and with or without CML was selected using ICD-10 diagnosis code. Principal diagnosis of congestive heart failure and cardiogenic shock were included with the code. Discharge-level weight analysis was used to produce national estimate. Continuous variables were compared by t-test, while chi-square and Fisher's exact test for categorical variables. Finally, multivariate logistic regression was used to calculate odds ratio for inpatient mortality and multivariate linear regression for length of stay using STATA 17 statistical software.

Results

A total of 45,724,104 admissions met for inclusion criteria and 43,505 patients (0.095 %) have CML. Patients with CML are more likely to be of older age (75.2 v 74.9, p <0.002), male (55.2% v 46.8%, p < 0.0001) and white (79.7% v 76.0%, p < 0.0001). They are also associated with lower prevalence of diabetes (16.5% v 20.1%, p < 0.0001) and smoking (0.6% v 0.8%, p <0.0001) but higher prevalence of peripheral arterial diseases (13.7% v 11.6%, p <0.0001). During the study period, a total of 9,339,737 patients were admitted primarily due to CHF and 12,835 of patients (0.14%) have underlying CML. There was no statistical difference in deteriorating to cariogenic shock in CHF patients with and without CML (2.06% v 2.10%, p <0.805). After adjusting for age, sex, race, diabetes, Charlson comorbidity index, there was statistical significance in mortality (OR 1.18, CI 1.09 - 1.27, p < 0.0001) and longer length of stay by 0.28 day (p < 0.0001)

Discussions

This study describes patient's demographic, in-patient mortality rate and length of stay in patients with CML and heart failure. A comorbid heart failure is associated with higher mortality rate and longer length of stay in hospital. Even though multiple societies have published several guidelines for baseline assessment of the cardiovascular risk factors, there is no standardized assessment tool for risk stratification and management of heart failure in CML patients. Moreover, presence of heart failure can be a limitation on treatments of CML and carry a poor prognosis. Our study emphasizes the importance of assessing cardiovascular diseases and optimizing the care before, during and after the treatment of CML.