Patel, Brijesh

e24014 Background: Cardio-oncology traditionally focuses on cardiotoxicity prevention and acute cardiovascular-events. However, the functional, vocational, and mental health challenges that define daily survivorship remain largely hidden, representing a critical gap in holistic care. Methods: Utilizing the 2024 National Health Interview Survey (NHIS), we analyzed a nationally representative cohort of U.S. adults (≥18 years) across four groups: (1) Controls (no cancer or CVD), (2) CVD only, (3) cancer only, and (4) cardio-oncology. We evaluated five patient-centered metrics reflecting quality of life: functional and work limitations, assistive equipment use, personal assistance needs, and overall disability. Multivariable regression models, using Taylor series linearization for complex survey weighting, were adjusted for age, sex, race, hypertension, diabetes, hyperlipidemia, smoking, psychological distress (K6 score), and insurance status. Results: Among 32,599 adults (Weighted N = 259.7M), 2.9% lived with cardio-oncology multi-morbidity (weighted N = 5.34M; mean age 73y). After multivariable adjustment, functional limitations were highest in the cardio-oncology (63.6%, OR 2.34 [95%CI 1.89-2.88]), exceeding both CVD only (OR 1.99) and cancer only (OR = 1.26) groups. This population was also at the highest risk of disability (OR 2.74) and work limitations (31.7%, OR = 2.53). One in five cardio-oncology survivors reported severe mobility impairment (difficulty walking/steps), with a need for assistive equipment (OR = 2.86) and personal assistance (OR = 1.38). Conclusions: Cardio-oncology survivors face a functional and vocational burden significantly exceeding that of cancer or CVD alone. Care models must expand beyond event prevention to integrate routine functional screening and early rehabilitation to preserve quality of life in this high-risk population. Adjusted odds ratios by disease phenotype. Outcome CVD Only (vs. Control) Cancer Only (vs. Control) Cardio-Oncology (vs. Control) OR (95% CI) OR (95% CI) OR (95% CI) Functional limitation 1.99 (1.75–2.28) 1.26 (1.14–1.39) 2.34 (1.89–2.88) Uses special equipment 2.56 (2.20–2.98) 1.26 (1.08–1.46) 2.86 (2.32–3.53) Needs assistance 1.51 (1.17-1.94) 0.84 (0.64-1.12) 1.38 (0.99-1.92) Work limitation 2.12 (1.88-2.39) 1.19 (1.07-1.33) 2.53 (2.11-3.03) Disability 2.20 (1.90–2.56) 1.11 (0.96–1.29) 2.74 (2.26–3.32) Note: Models adjusted for age, sex, race, hypertension, diabetes, hyperlipidemia, smoking status, psychological distress, and insurance type. Reference group = Adults with no history of cancer or CVD. CVD = Cardiovascular disease; OR = Odds Ratio; CI = Confidence Interval.

e23005 Background: Cardiovascular disease (CVD) is the leading non-cancer cause of death among cancer survivors. Managing this risk increasingly requires a transition from traditional generic therapies (e.g., statins, ACEi) to novel agents (e.g., SGLT2i, GLP-1RA). While these drugs are clinically recommended for survivors comorbidities, their population level economic impact has not been well defined. Methods: We analyzed the 2016–2023 Medical Expenditure Panel Survey (MEPS-HC) to identify U.S. adults with a history of cancer (n=5,165; weighted ~54.3M) and non-cancer controls (n=217,834). We evaluated utilization, total prescription expenditures, and out-of-pocket (OOP) costs across 10 cardioprotective drug classes: statins, ACE inhibitors, ARBs, aspirin, antiplatelets, ezetimibe, GLP-1RA, SGLT2i, PCSK9i, and colchicine. surgery-weighted Pearson chi-square tests and design-based F-statistics accounted for the complex sampling design. Results: Cancer survivors were older (mean age ~68 vs 46 years), with higher prevalence of hypertension (54.5% vs 31.5%), diabetes (18.7% vs 8.1%), and dyslipidemia (56.1% vs 23.1%) than controls (all p<0.001). Survivors more frequently used traditional cardioprotective therapies, including statins (43.7% vs 23.1%) and ACE/ARBs (35.8% vs 18.2%). Aspirin use remained common and stable with negligible expenditures and OOP costs, reflecting its role as a low-cost foundational therapy. Antiplatelet use was higher among survivors and associated with modest but persistent OOP spending. Between 2016 and 2023, mean annual per-patient statin expenditures declined by 65% ($177 to $61). In contrast, expenditures for novel agents increased substantially. Mean per-person SGLT2 inhibitor expenditures rose from $0.36 to $211.55, while GLP-1RA utilization increased from 2.0% to 20.5%. These shifts increased patient cost sharing: survivor OOP costs increased 40-fold for SGLT2 inhibitors ($0.35 to $13.91) and more than four-fold for GLP-1 receptor agonists ($3.69 to $15.83). Socioeconomic disparities were evident, with PCSK9 inhibitor users reporting higher family incomes than non-users ($123,069 vs $85,530), and ezetimibe utilization was higher among Black compared with White survivors (14.8% vs 9.5%; p<0.05). Conclusions: Among U.S. cancer survivors, declining costs of generic cardioprotective therapies have been fully offset by rising expenditures and OOP burdens from newer agents. Access to high-value therapies increasingly reflects socioeconomic disparities more than clinical risk alone. Reducing patient cost sharing will be essential to prevent financial barriers from worsening adherence and long-term cardiovascular outcomes in survivorship.