# Associations Between Pre‐Existing Cardiovascular Disease and Survival in Patients on Immune Checkpoint Inhibitor Therapy

## TL;DR

This study finds that pre-existing heart conditions are linked to higher mortality in cancer patients treated with immune checkpoint inhibitors.

## Contribution

The study identifies specific cardiovascular conditions that significantly affect survival in patients receiving immune checkpoint inhibitor therapy.

## Key findings

- Systolic heart failure is associated with a 38% higher mortality risk in ICI-treated patients.
- Atrial fibrillation/flutter increases mortality risk by 24% in patients undergoing ICI therapy.
- Baseline cardiovascular data should be captured in future ICI trials to improve risk assessment and treatment strategies.

## Abstract

The impact of baseline cardiovascular disease (CVD) on survival in patients undergoing immune checkpoint inhibitor (ICI) therapy is not well understood. Therefore, we sought to determine the relationship between baseline CVD on mortality in patients undergoing ICI monotherapy or combination therapy.

Using TriNetX, a global database of over 120 million patients, we identified 27,820 patients with pre‐existing cardiovascular disease prior to starting ICI monotherapy and an equal number of corresponding matched controls.

Systolic heart failure (HR: 1.38, 95% CI: 1.29–1.48), diastolic heart failure (HR: 1.34, 95% CI: 1.27–1.42), and atrial fibrillation/flutter (HR: 1.24, 95% CI: 1.19–1.29) had the greatest associations with mortality across ICI monotherapy.

Future trials of patients initiating ICI therapy should capture these baseline values to guide risk assessment, pretreatment optimization, and surveillance strategies prior to treatment initiation.