University of Leicester
Browse
zuad020.pdf (2.25 MB)

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

Download (2.25 MB)
journal contribution
posted on 2023-05-17, 09:17 authored by Briana Coles, Catherine A Welch, Rishabh S Motiwale, Lucy Teece, Clare Oliver-Williams, Clive Weston, Mark A de Belder, Paul C Lambert, Mark J Rutherford, Lizz Paley, Umesh T Kadam, Claire A Lawson, John Deanfield, Michael D Peake, Theresa McDonagh, Michael J Sweeting, David Adlam

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.

Funding

Cancer Research UK (C53325/A21134)

Cardio-oncology: A high resolution national electronic health record investigation of the interplay between cancer and heart disease (Joint funding with CRUK)

British Heart Foundation

Find out more...

National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM)

History

Author affiliation

Department of Cardiovascular Sciences, University of Leicester

Version

  • VoR (Version of Record)

Published in

European heart journal. Acute cardiovascular care

Volume

12

Issue

5

Pagination

315-327

Publisher

Oxford University Press (OUP)

issn

2048-8726

eissn

2048-8734

Copyright date

2023

Available date

2023-05-17

Spatial coverage

England

Language

eng

Usage metrics

    University of Leicester Publications

    Categories

    Licence

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC