Failure-to-rescue after acute cardiac events in cancer versus non-cancer hospitalizations.

Abstract

e23241 Background: Acute cardiac complications are major drivers of inpatient mortality, yet outcomes after theseevents may differ in patients with cancer due to reduced physiologic reserve, treatment-relatedcardiotoxicity, and competing critical illness. Failure-to-rescue (FTR), defined as death after acomplication, provides a systems-level framework to quantify vulnerability and gaps in careescalation. We evaluated whether mortality after acute cardiac complications is higher inhospitalizations among patients with cancer compared with non-cancer hospitalizations. Methods: We performed a serial cross-sectional analysis of the 2018–2022 National Inpatient Sampleusing discharge-level survey weighting. Adult hospitalizations were classified as cancer(principal malignancy) or non-cancer. Acute cardiac complications were identified usingICD-10-CM codes for acute myocardial infarction (AMI; I21–I22), arrhythmia (I47–I49), andshock. FTR was defined as in-hospital mortality among hospitalizations with each complication.Survey-weighted multivariable logistic regression estimated the association between cancerstatus and FTR within each event cohort, adjusting for demographics, payer, ZIP-code incomequartile, elective status, year, and hospital characteristics. Results: Acute cardiac complications were common (AMI 4.43%; arrhythmia 19.01%). In unadjustedanalyses, FTR after AMI was higher in cancer versus non-cancer hospitalizations (19.1% vs9.0%), as was FTR after arrhythmia (8.3% vs 6.0%). In the composite cohort of any acutecardiac complication, hospitalizations among patients with cancer demonstrated higher FTRmortality (10.0% vs 6.1%).After adjustment, cancer status remained associated with higher FTR after AMI (adjusted oddsratio [aOR] 2.26, 95% CI 2.13–2.39) and arrhythmia (aOR 1.67, 95% CI 1.63–1.71). In thecomposite cohort, cancer was associated with nearly doubled odds of death (aOR 2.00, 95% CI1.95–2.04). Cancer status could not be independently estimated in shock-only admissions because of collinearity. Cancer significantly modified the association between cardiaccomplications and mortality (interaction OR 1.16, 95% CI 1.12–1.20). Conclusions: Hospitalizations among patients with cancer demonstrate substantially higher failure-to-rescueafter acute cardiac complications, particularly following myocardial infarction and arrhythmia.These findings highlight FTR as a practical inpatient quality metric and highlight the need forearlier recognition, aggressive escalation, and standardized rescue pathways for cardiacdecompensation in oncology populations.