This study, published in the European Journal of Heart Failure, explores the clinical characteristics, management, and outcomes of patients with heart failure (HF) who also have a history of cancer. Drawing from the ESC-HFA EORP Heart Failure Long-Term Registry, the research evaluated 9,017 patients, 904 (10%) of whom had a past cancer diagnosis. The most common cancers reported were breast, prostate, and gastrointestinal.
Patients with prior cancer tended to be older, more often male, and had a higher prevalence of atrial fibrillation, ischemic heart disease, and kidney dysfunction. Despite having similar rates of left ventricular ejection fraction (LVEF) as those without cancer, patients with cancer had more symptoms, lower physical activity levels, and a higher burden of non-cardiac comorbidities. Interestingly, they received fewer guideline-directed medical therapies and device therapies, possibly due to concerns over frailty or drug tolerability.
After adjusting for confounders, a history of cancer was independently associated with a significantly higher risk of all-cause mortality over a median 12-month follow-up (hazard ratio [HR] 1.41). Importantly, this risk remained elevated regardless of whether the cancer was recent (<5 years) or more remote (>5 years). However, cancer history was not linked to an increased rate of HF hospitalization, suggesting that excess mortality may relate to non-cardiac factors or less aggressive cardiovascular management.
The study highlights the underrepresentation of patients with cancer in HF clinical trials, despite being a sizable and clinically distinct subgroup. The authors advocate for a multidisciplinary, cardio-oncology approach to ensure optimal care and decision-making for this high-risk population. They also stress the importance of individualized risk-benefit assessments when prescribing therapies in cancer survivors with HF.
In summary, heart failure patients with a history of cancer represent a vulnerable population with worse survival outcomes and lower treatment rates. Tailored management strategies and greater inclusion in clinical research are essential to improve their long-term prognosis and quality of care.
Source: https://onlinelibrary.wiley.com/doi/10.1002/ejhf.3775
