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

Edoardo Bertero; Fabio Robusto; Eliana Rulli; Antonio D'Ettorre; Lucia Bisceglia; Lidia Staszewsky; Christoph Maack; Vito Lepore; Roberto Latini; Pietro Ameri

doi:10.1016/j.jaccao.2021.11.007

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

JACC CardioOncol. 2022 Jan 18;4(1):98-109. doi: 10.1016/j.jaccao.2021.11.007. eCollection 2022 Mar.

Authors

Edoardo Bertero^{1

2

3}, Fabio Robusto⁴, Eliana Rulli⁵, Antonio D'Ettorre⁶, Lucia Bisceglia⁷, Lidia Staszewsky⁶, Christoph Maack³, Vito Lepore⁶, Roberto Latini⁶, Pietro Ameri^{1

2}

Affiliations

¹ Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Italian IRCCS Cardiology Network, Genoa, Italy.
² Department of Internal Medicine, University of Genoa, Genoa, Italy.
³ Comprehensive Heart Failure Center, University Clinic Würzburg, Würzburg, Germany.
⁴ Medonline-Statte, Azienda Sanitaria Locale TA, Taranto, Italy.
⁵ Department of Oncology, Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
⁶ Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
⁷ Epidemiology and Care Intelligence Area, Regional Health Agency of Puglia, Bari, Italy.

Abstract

Background: Studies assessing whether heart failure (HF) is associated with cancer and cancer-related mortality have yielded conflicting results.

Objectives: This study assessed cancer incidence and mortality according to pre-existing HF in a community-based cohort.

Methods: 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.

Results: 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).

Conclusions: HF is associated with an increased risk of cancer and cancer-related mortality, which may be heightened in decompensated states.

Keywords: ATC, Anatomical Therapeutic Chemical; CCI, Charlson comorbidity index; DDCI, drug-derived complexity index; DP, drug prescription; HDR, hospital discharge record; HF, heart failure; HFW, health care cost-related fee waiver; ICD-9-CM, International Classification of Diseases-Ninth Revision-Clinical Modification; IR, incidence rate; SHR, subdistribution HR; cancer; cardio-oncology; comorbidity; heart failure; mortality.