CHANGES IN CARDIOVASCULAR-RELATED MORTALITY AMONG U.S. ADULTS WITH CANCER AFTER INTRODUCTION OF CARDIO-ONCOLOGY GUIDELINES: AN INTERRUPTED TIME SERIES ANALYSIS
Author(s)
Nguyen Le, BSc, MBA1, Ayobami A. Aiyeolemi, BSc1, Yan Liu, MD, PhD2, Chanhyun Park, MEd, RPh, PhD1;
1The University of Texas at Austin, Health Outcomes Division, College of Pharmacy, Austin, TX, USA, 2Dell Medical School at the University of Texas at Austin, Department of Internal Medicine, Austin, TX, USA
1The University of Texas at Austin, Health Outcomes Division, College of Pharmacy, Austin, TX, USA, 2Dell Medical School at the University of Texas at Austin, Department of Internal Medicine, Austin, TX, USA
OBJECTIVES: Cancer-related survival rates have improved in the U.S. making cardiovascular (CV) mortality a more significant competing risk in cancer patients. To evaluate the population-level impact of cardio-oncology guidelines (COG), we assessed changes in CV mortality among U.S. adults with cancer after the first guidelines were introduced in October 2014.
METHODS: We conducted a population-based segmented interrupted time series analysis using CDC WONDER Multiple Cause of Death data (January 2008-March 2020). We included deaths among adults aged ≥25 years with malignant neoplasms (ICD-10: C00-C97) and diseases of the circulatory system (ICD-10: I00-I99) listed as multiple causes of death. We defined the intervention period as beginning in January 2015 to account for guideline dissemination (3-month lag from October 2014 publication). We fit segmented Poisson regression models with a log link and the U.S. population as an offset, adjusting for age group, sex, and month (seasonality) and accounting for autocorrelation.
RESULTS: We identified 2,245,891 CV-related mortality cases among adults with cancer during the study period. After January 2015, we observed a non-significant immediate level decrease (incidence rate ratio [IRR]= 0.9885 [95% CI: 0.9652 to 1.0124]) and a statistically significant in the postintervention trend (IRR = 1.0022 [95% CI: 1.0015 to 1.0029]) in monthly CV mortality rate. After adjustment, the gradual increase persisted (IRR = 1.0020 [95% CI: 1.0015 to 1.0025).
CONCLUSIONS: The post-guideline period was associated with a statistically significant gradual increase in CV mortality among adults with cancer. This pattern may reflect survivorship, cardiotoxic therapies, and secular changes in cardiovascular risk; longer follow-up may be needed to detect guideline-related effects on CV outcomes.
METHODS: We conducted a population-based segmented interrupted time series analysis using CDC WONDER Multiple Cause of Death data (January 2008-March 2020). We included deaths among adults aged ≥25 years with malignant neoplasms (ICD-10: C00-C97) and diseases of the circulatory system (ICD-10: I00-I99) listed as multiple causes of death. We defined the intervention period as beginning in January 2015 to account for guideline dissemination (3-month lag from October 2014 publication). We fit segmented Poisson regression models with a log link and the U.S. population as an offset, adjusting for age group, sex, and month (seasonality) and accounting for autocorrelation.
RESULTS: We identified 2,245,891 CV-related mortality cases among adults with cancer during the study period. After January 2015, we observed a non-significant immediate level decrease (incidence rate ratio [IRR]= 0.9885 [95% CI: 0.9652 to 1.0124]) and a statistically significant in the postintervention trend (IRR = 1.0022 [95% CI: 1.0015 to 1.0029]) in monthly CV mortality rate. After adjustment, the gradual increase persisted (IRR = 1.0020 [95% CI: 1.0015 to 1.0025).
CONCLUSIONS: The post-guideline period was associated with a statistically significant gradual increase in CV mortality among adults with cancer. This pattern may reflect survivorship, cardiotoxic therapies, and secular changes in cardiovascular risk; longer follow-up may be needed to detect guideline-related effects on CV outcomes.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH2
Topic
Epidemiology & Public Health
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Oncology