Trends in the prevalence of malignancy among patients admitted with acute heart failure and associated outcomes: a nationwide population-based study

• Published in: Heart failure reviews 2019-11, Vol.24 (6), p.989-995
• Main Authors: Ram, Pradhum, Tiu, Andrew, Lo, Kevin Bryan, Parikh, Kaushal, Shah, Mahek
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Aged, 80 and over; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - epidemiology; Cancer Survivors - statistics & numerical data; Cardiology; Cardiotoxicity - complications; Cardiotoxicity - epidemiology; Cardiovascular disease; Cardiovascular diseases; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Comorbidity; Congestive heart failure; Coronary artery; Diabetes mellitus; Diagnosis; Female; Heart failure; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - mortality; Hospital Mortality - trends; Hospitalization - trends; Humans; Kidney diseases; Lung cancer; Lung Neoplasms - diagnosis; Lung Neoplasms - epidemiology; Male; Malignancy; Medical diagnosis; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Multivariate analysis; Neoplasms - complications; Neoplasms - epidemiology; Neoplasms - mortality; Patients; Population studies; Population-based studies; Prevalence; Prostate cancer; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - epidemiology; Risk Factors; Smoking; Toxicity; Trends
• ISSN: 1382-4147; 1573-7322
• DOI: 10.1007/s10741-019-09808-y

Cancer is the second leading cause of death in the USA, and cardiovascular disease is the second leading cause of morbidity and mortality among cancer survivors. Cancer survivors share common risk factors for cardiovascular disease with non-cancer patients. With improved survival, cancer patients become susceptible to treatment-related toxicity often involving the heart. The impact of concurrent malignancy on outcomes particularly among heart failure patients is an area of active research. We studied the trends in the prevalence of a concurrent diagnosis of breast, prostate, colorectal, and lung cancer among admissions for acute heart failure and the associated trends for in-hospital mortality. Patients aged ≥ 18 years who were admitted with a primary diagnosis of “congestive heart failure” (CCS codes 99 and 108) from years 2003 to 2014 were included. We analyzed the rate of admission and in-hospital mortality among patients who had a concurrent diagnosis for either lung cancer, colorectal cancer, breast cancer (among females), or prostate cancer (among males). We performed a multivariate analysis to assess the role of a concurrent diagnosis of any cancer in predicting in-hospital mortality among HF admissions. From 2003 to 2014 across over 12 million HF admissions, ≈ 7% had a concurrent diagnosis of either lung, breast, colorectal, or prostate cancer. The prevalence was highest for breast cancer (2.3%) followed by prostate cancer (2.1%) and colorectal cancer (1.5%) and lowest with lung cancer (1.1%). The prevalence of cancer increased over the duration of study among all four cancer types with the largest increase in prevalence of breast cancer. Baseline comorbidities including hypertension, diabetes, smoking, chronic kidney disease, and coronary artery disease increased over time among patients with and without cancer. In-hospital mortality was higher among those with a diagnosis of lung cancer (5.9%) followed by colorectal cancer (4.0%), prostate cancer (3.5%), no diagnosis of cancer (3.3%), and breast cancer (3.2%). In-hospital mortality declined across HF admissions with and without a cancer diagnosis from 2003 to 2014. Decline in such mortality among heart failure was highest for patients with lung cancer (8.1 to 4.6% from 2003 to 2014; p