Rong-Hua Wang,1 Yin Chen,1 Ya-Ling Lou,1 Yu-Liang Lu,2 Hui-Min Xu3 

1Department of Pharmacy, HuZhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Huzhou, People’s Republic of China; 2Department of Cardiology, HuZhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Huzhou, People’s Republic of China; 3Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China

Correspondence: Rong-Hua Wang, Department of Pharmacy HuZhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), No. 1558 Sanhuan North Road, Wuxing District, Huzhou, Zhejiang, 313000, People’s Republic of China, Email legend.blue@163.com Hui-Min Xu, Department of Pharmacy Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang, 310009, People’s Republic of China, Email xuhuimin78@zju.edu.cn

Purpose: This study aimed to elaborate on the incidence, clinical features, and management of immune checkpoint inhibitors (ICIs) related cardiovascular adverse events (CVAEs) in real-world practice.
Patients and Methods: We performed a retrospective chart review study on patients receiving at least one dose of ICI therapy at a Chinese tertiary hospital from March 2020 to March 2021. CVAEs were identified through clinical assessment and the Naranjo algorithm. The management and outcomes of CVAEs were monitored over a median follow-up duration of 8 months.
Results: Among the included 203 patients, 4.4% (9/203) developed CVAEs, including heart failure (n = 3), arrhythmia (n = 2), myocarditis (n = 2), and pericardial disease (n = 2), with a proportion (6/9) tending to be severe (grade 3 or grade 4). CVAEs were more common in older patients (mean age: 73.6 ± 9.2 years) and those with hypertension (p = 0.02) or heart failure (p = 0.01). Adherence to the American Society of Clinical Oncology (ASCO) guidelines for managing CVAEs was low (44%), with most cases showing partial resolution by the last follow-up.
Conclusion: We reported that the incidence of ICI-related CVAEs in the Chinese institution was higher than that in some prior studies. Adherence to guidelines for managing ICI-related CVAEs is found to be suboptimal in real-world practice and highlighted as a needed improvement.

Keywords: immune checkpoint inhibitors, cardiotoxicity, retrospective study