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

Coles, B; Welch, CA; Motiwale, RS; Teece, L; Oliver-Williams, C; Weston, C; de Belder, MA; ... Charlton, P; + view all (2023) Acute heart failure presentation, management, and outcomes in cancer patients: a national longitudinal study. European Heart Journal: Acute Cardiovascular Care , 12 (5) pp. 315-327. 10.1093/ehjacc/zuad020. Green open access

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Abstract

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.

Type: Article
Title: Acute heart failure presentation, management, and outcomes in cancer patients: a national longitudinal study
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/ehjacc/zuad020
Publisher version: https://doi.org/10.1093/ehjacc/zuad020
Language: English
Additional information: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Male, Humans, Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Antagonists, Patient Discharge, Longitudinal Studies, Retrospective Studies, Aftercare, Cohort Studies, Heart Failure, Stroke Volume, Neoplasms
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10173981
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