Cancer Incidence and Mortality According to Pre-Existing Heart Failure in a Community-Based Cohort

• Published in: JACC CardioOncology Vol. 4; no. 1; pp. 98 - 109
• Main Authors: Bertero, Edoardo, Robusto, Fabio, Rulli, Eliana, D’Ettorre, Antonio, Bisceglia, Lucia, Staszewsky, Lidia, Maack, Christoph, Lepore, Vito, Latini, Roberto, Ameri, Pietro
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2022; Elsevier
• Subjects: cancer; cardio-oncology; Cardiovascular; comorbidity; heart failure; Mini-Focus Issue: Epidemiologic and Biologic Links Between Cancer and CV Disease; mortality; heart failure; CCI; IR; cardio-oncology; DP; ATC; comorbidity; ICD-9-CM; HDR; mortality; HFW; DDCI; cancer; SHR; HF; Anatomical Therapeutic Chemical; International Classification of Diseases-Ninth Revision-Clinical Modification; incidence rate; hospital discharge record; subdistribution HR; Charlson comorbidity index; drug-derived complexity index; drug prescription; health care cost-related fee waiver; ATC, Anatomical Therapeutic Chemical; CCI, Charlson comorbidity index; HFW, health care cost-related fee waiver; DDCI, drug-derived complexity index; HDR, hospital discharge record; DP, drug prescription; ICD-9-CM, International Classification of Diseases-Ninth Revision-Clinical Modification; IR, incidence rate; SHR, subdistribution HR; HF, heart failure
• ISSN: 2666-0873; 2666-0873
• DOI: 10.1016/j.jaccao.2021.11.007

Studies assessing whether heart failure (HF) is associated with cancer and cancer-related mortality have yielded conflicting results. This study assessed cancer incidence and mortality according to pre-existing HF in a community-based cohort. Among individuals ≥50 years of age from the Puglia region in Italy with administrative health data from 2002 to 2018, no cancer within 3 years before the baseline evaluation, and ≥5-year follow-up, the study matched 104,020 subjects with HF at baseline with 104,020 control subjects according to age, sex, drug-derived complexity index, Charlson comorbidity index, and follow-up duration. Cancer incidence and mortality were defined based on International Classification of Diseases-Ninth Revision codes in hospitalization records or death certificates. The incidence rate of cancer in HF patients and control subjects was 21.36 (95% CI: 20.98-21.74) and 12.42 (95% CI: 12.14-12.72) per 1000 person-years, respectively, with the HR being 1.76 (95% CI: 1.71-1.81). Cancer mortality was also higher in HF patients than control subjects (HR: 4.11; 95% CI: 3.86-4.38), especially in those <70 years of age (HR: 7.54; 95% CI: 6.33-8.98 vs HR: 3.80; 95% CI: 3.44-4.19 for 70-79 years of age; and HR: 3.10; 95% CI: 2.81-3.43 for ≥80 years of age). The association between HF and cancer mortality was confirmed in a competing risk analysis (subdistribution HR: 3.48; 95% CI: 3.27-3.72). The HF-related excess risk applied to the majority of cancer types. Among HF patients, prescription of high-dose loop diuretic was associated with higher cancer incidence (HR: 1.11; 95% CI: 1.03-1.21) and mortality (HR: 1.35; 95% CI: 1.19-1.53). HF is associated with an increased risk of cancer and cancer-related mortality, which may be heightened in decompensated states. [Display omitted]