Neoplasias en pacientes con insuficiencia cardiacaincidencia, pronóstico y factores de riesgo

Abstract

Objectives: During the last years publications have emerged suggesting heart failure (HF) might be an independent risk factor of cancer. Nevertheless, evidence published is for the time being weak. Therefore, the main endpoint of this study is to assess in patients with HF the incidence of the new diagnosis of malignancy, to analyse the major risk factors associated to the development of neoplasms, and to determinate its mortality and prognosis, comparing these outcomes with those related to the general population. As secondary endpoint, we analyse in addition the prognosis of HF in patients with a previous history of malignancy. Methods: We conducted an observational and single-center study based in a prospective cohort of patients with HF referred to the Advanced Heart Failure Unit of the Cardiology Service of A Coruña Universitary Hospital Complex, in Spain, since its creation in 2010 until 2019. Non-melanoma skin cancer was specifically excluded from the definition of newly diagnosed malignancies, with the purpose to compare our results with those estimated for the general Spanish population according to the Global Cancer Observatory. Results: During follow-up of 1909 consecutive patients with HF over a median time of 4.07 years, 165 new cases of malignancy were diagnosed. Observed age-standardized incidence rates of cancer per 100,000 persons-years were 861 cases (95% Confidence Interval (CI) 618.4–2,159.4) in men and 728.5 cases (95% CI 451.1–4,308.7) in women in the HF group; while age-standardized incidence rates of cancer expected for the general Spanish population per 100,000 persons-years were 479.4 cases in men (risk ratio = 1.80) and 295.5 cases in women (risk ratio = 2.46). Both a history of pre-existing malignancy at baseline and the development of new malignancies during follow-up were associated with reduced survival. Observed age-standardized cancer-related mortality rates per 100,000 persons-years were 344.1 deaths (95% CI 202.1–1675) in men and 217 deaths (95% CI 32.8–3949.3) in women in the HF population; while age-standardized cancer-related mortality rates per 100,000 persons-years expected for the general Spanish population were 201.4 deaths in men (risk ratio = 1.71) and 96.2 deaths per 100,000 persons-years in women (risk ratio = 2.26). Conclusions: Patients with HF showed higher incidence rates of cancer diagnosis and cancer-related mortality than those expected for the general population, both in women and in men, being the survival after a new diagnosis of malignancy poor.