Do patients have worse outcomes in heart failure than in cancer? A primary care‐based cohort study with 10‐year follow‐up in Scotland

Abstract

Aims: To evaluate whether the survival rates of patients with heart failure (HF) in the community are better than those with a diagnosis of the 4 most common cancers in men and women in a contemporary primary care cohort in Scotland. Methods and Results:The data were obtained from the Primary Care Clinical Informatics Unit from a database of 1.75 million people registered with 393 general practices in Scotland. Sex-specific survival modeling was undertaken using Cox proportional hazards models, adjusted for potential confounders. A total of 56,658 patients were eligible to be included in the study with 147,938 person years follow up (median follow up 2.04 years). In men, heart failure (reference group; 5yrs survival 37.7%) had worse mortality outcomes than patients with prostate cancer (HR 0.61, 95%CI 0.57-0.65; 5yrs survival 49.0%), and bladder cancer (HR 0.88, 95%CI 0.81-0.96; 5yrs survival 36.5%), but better than lung cancer (HR 3.86, 95%CI 3.65-4.07; 5yrs survival 2.8%) and colorectal cancer (HR 1.23 95%CI 1.16-1.31; 5 yrs survival 25.9%). In women, patients with HF (reference group; 5yrs survival 31.9%) had worse mortality outcomes than patients with breast cancer (HR 0.55 95%CI 0.51-0.59; 5yrs survival 61.0%), but better outcomes than lung cancer (HR 3.82, 95%CI 3.60-4.05; 5yrs survival 3.6%), ovarian cancer (HR 1.98, 95%CI 1.80-2.17; 5yrs survival 19%) and colorectal cancer (HR 1.21, 95%CI 1.13-1.29; 5yrs survival 28.4%). Conclusions:Despite advances in management, heart failure remains as 'malignant' as some of the common cancers in both men and women.3

Recent advances in cardio‐oncology: a report from the ‘Heart Failure Association 2019 and World Congress on Acute Heart Failure 2019’

“…Frequent problems include, but are not limited to, chronic kidney disease, 3,4 liver dysfunction, 5,6 gastrointestinal disease, 7,8 anaemia, 9,10 fatigue, 11,12 infections, 13,14 anorexia 15,16 , muscle wasting, 17,18 pain, 19,20 and heart failure (HF). 23 HF is associated with a 5-year survival rate of nearly 50% [24][25][26] and is frequently accompanied by reduced quality of life. 23 HF is associated with a 5-year survival rate of nearly 50% [24][25][26] and is frequently accompanied by reduced quality of life.…”

Providing Heart Failure Rehabilitation in the Home via Telerehabilitation

“…Although survival rates have improved, the absolute mortality rates for CHF remain approximately 50% within five years of diagnosis (Levy et al, 2002), and this patient group continues to have lower survival rates than patients with common cancers such as breast and prostate cancers (Mamas et al, 2017). Recent…”

Persistently misunderstood and malignant: the case of heart failure vs. cancer

“…Previous like‐for‐like comparisons of heart failure vs. cancer‐related survival have suggested that the former is indeed as ‘malignant’ as the most common forms of cancer with the notable exception of lung cancer, a condition that, like heart failure, has not attracted the attention it most probably deserves. Whether it is still legitimate to label heart failure as malignant as cancer (particularly when considering that previous studies have focused on hospitalized cohorts) is the focus of a study undertaken by Mamas and colleagues . Using population‐based primary care data from Scotland, the authors examined the survival profiles of 56 658 patients newly diagnosed with heart failure or the most common forms of cancer.…”

“…In women (1‐ and 5‐year mortality of 15% and 40%), heart failure was more ‘malignant’ than breast cancer but not lung, ovarian, and colorectal cancer. As appropriately described in the report, therefore, it is probably legitimate to label heart failure as malignant as many forms of cancer . However, as highlighted by a recent late‐breaking report on 1‐year survival rates within the INTERnational Congestive Heart Failure (INTER‐CHF) Study cohort derived from a range of low‐ and middle‐income countries there is considerable heterogeneity in the profiles and outcomes associated with heart failure across the globe.…”