Acute heart failure presentation, management, and outcomes in cancer patients: a national longitudinal study.

Aims: Currently, little evidence exists on survival and quality of care in cancer patients presenting with acute heart failure (HF). The aim of the study is to investigate the presentation and outcomes of hospital admission with acute HF in a national cohort of patients with prior cancer.
Methods and Results: This retrospective, population-based cohort study identified 221 953 patients admitted to a hospital in England for HF during 2012-2018 (12 867 with a breast, prostate, colorectal, or lung cancer diagnosis in the previous 10 years). We examined the impact of cancer on (i) HF presentation and in-hospital mortality, (ii) place of care, (iii) HF medication prescribing, and (iv) post-discharge survival, using propensity score weighting and model-based adjustment. Heart failure presentation was similar between cancer and non-cancer patients. A lower percentage of patients with prior cancer were cared for in a cardiology ward [-2.4% age point difference (ppd) (95% CI -3.3, -1.6)] or were prescribed angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists (ACEi/ARB) for heart failure with reduced ejection fraction [-2.1 ppd (-3.3, -0.9)] than non-cancer patients. Survival after HF discharge was poor with median survival of 1.6 years in prior cancer and 2.6 years in non-cancer patients. Mortality in prior cancer patients was driven primarily by non-cancer causes (68% of post-discharge deaths).
Conclusion: Survival in prior cancer patients presenting with acute HF was poor, with a significant proportion due to non-cancer causes of death. Despite this, cardiologists were less likely to manage cancer patients with HF. Cancer patients who develop HF were less likely to be prescribed guideline-based HF medications compared with non-cancer patients. This was particularly driven by patients with a poorer cancer prognosis.
Competing Interests: Conflict of interest: M.S., B.C., L.T., M.R., P.C.L., D.A., and M.P. had financial support from the British Heart Foundation and Cancer Research UK for the submitted work; D.A. has received research funding and in-kind support for unrelated research from AstraZeneca Inc. He has received an educational grant from Abbott Vascular Inc. to support a clinical research fellow for unrelated research. He has also conducted consultancy for GE Inc. to support research funds for unrelated research; B.C. previously received funding from Novo Nordisk; J.D. had financial support from the British Heart Foundation in the previous 3 years; M.S. is an employee of AstraZeneca and owns shares in AstraZeneca. C.W. is Clinical Lead of the Myocardial Ischaemia National Audit Project (MINAP); M.d.B. reports DSMB membership of the UK GRIS Trial, chair of the ARREST Trial Steering Committee, and Executive Member of the DAPA-MI Trial; no other relationships or activities that could appear to have influenced the submitted work have been reported.
(© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)