Cardiovascular disease is increasingly recognized as an important contributor to morbidity and mortality among patients with hematologic malignancies.

However, the impact of cardiovascular comorbidities on outcomes in hospitalized leukemia patients remains incompletely characterized. 

We evaluated the association between cardiovascular comorbidities and in hospital mortality among patients hospitalized with leukemia in the United States. 

• Design: Retrospective cohort study using the National Inpatient Sample Analysis (2018-2023)

• Population: Adult hospitalizations (age > 18 years old) with leukemia identified using ICD-10 codes: 

• AML (C92.0), CML (C92.1), CLL (C91.10-C91.12)

• Cardiovascular Comorbidities: Heart Failure (HF), Myocardial Infarction (MI), Stroke/Transient Ischemic Attack (TIA), Peripheral Arterial Disease (PAD), and Atrial Fibrillation (AF).

• Outcomes: In Hospital Mortality

• Analysis: Survey-weighted multivariable logistic regression adjusting for demographics, leukemia subtype, hospital characteristics, and comorbidities including CKD, diabetes, hypertension, obesity, COPD, liver disease and sepsis.

  • A total of 202, 747 leukemia hospitalizations were identified representing approximately 1,013,395 weighted admissions nationwide.

  • Several cardiovascular comorbidities were independently associated with increased morbidity and mortality.

  • Each additional cardiovascular comorbidity increased mortality risk by 37% (OR 1.37, p<0.001).

  • Sepsis was the strongest predictor of in hospital mortality (OR 5.60, p<0.001). 

    • Cardiovascular comorbidities significantly contribute to mortality risk among hospitalized leukemia patients with acute ischemic events such as MI and stroke showing the greatest impact. 

    • The graded increase in mortality with combative cardiovascular burden underscores a dose response relationship, suggesting additive or synergistic effects.

    • These results align with emerging data highlighting shared inflammatory pathways, treatment related cardiotoxicity, and physiologic stress during acute illness as contributors to adverse outcomes.

    • The lower mortality observed with PAD may reflect residual confounding or differences in disease chronicity. 

    • Importantly, sepsis remained the dominant driver of mortality, emphasizing the interplay between infection, cardiovascular instability and malignancy.

    •  These findings support early cardiovascular risk stratification and multidisciplinary cardio-oncology collaboration.

      • Cardiovascular comorbidities are common and independently associated with increased inpatient mortality among leukemia hospitalizations.

      • Increasing cardiovascular burden confers progressively higher risk, highlighting the need for integrated cardio-oncologycare and early recognition of high risk patients.