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Bertero E, Robusto F, Rulli E, D’Ettorre A, Bisceglia L, Staszewsky L, Maack C, Lepore V, Latini R, Ameri P. Cancer Incidence and Mortality According to Pre-Existing Heart Failure in a Community-Based Cohort. JACC CardioOncol 2022; 4:98-109. [PMID: 35492831 PMCID: PMC9040106 DOI: 10.1016/j.jaccao.2021.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 12/11/2022] Open
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.
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Key Words
- 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
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Affiliation(s)
- Edoardo Bertero
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Italian IRCCS Cardiology Network, Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Comprehensive Heart Failure Center, University Clinic Würzburg, Würzburg, Germany
| | - Fabio Robusto
- Medonline-Statte, Azienda Sanitaria Locale TA, Taranto, Italy
| | - Eliana Rulli
- Department of Oncology, Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Antonio D’Ettorre
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Lucia Bisceglia
- Epidemiology and Care Intelligence Area, Regional Health Agency of Puglia, Bari, Italy
| | - Lidia Staszewsky
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Christoph Maack
- Comprehensive Heart Failure Center, University Clinic Würzburg, Würzburg, Germany
| | - Vito Lepore
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Roberto Latini
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Italian IRCCS Cardiology Network, Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Address for correspondence: Dr Pietro Ameri, IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6 – 16132 Genova, Italy.
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