Patients with heart failure (HF) have an increased risk of cancer, and cancer is associated with an increased mortality risk in HF, according to a study published June 25 in the Journal of the American College of Cardiology.

Additional Resources Full Study HF Clinical Toolkit 2013 ACCF/AHA Guideline for the Management of HF Lifelong Learning HF Pathway Heart Failure Self-Assessment Quiz CardioSmart for Your Patients: Learn About HF

The study was conducted in Olmsted County, Minn. as part of the Rochester Epidemiology Project, which included a comprehensive population-based data set and longitudinal follow-up, and compared 596 patients with HF and no history of cancer with 596 age- and gender-matched controls without HF or cancer. Over the course of 9,203 person-years of follow-up, the incidence of cancer was 68 percent higher among HF patients than controls [hazard ratio (HR) 1.68; 95 percent CI 1.13-2.50] after adjusting for body mass index, smoking and comorbidities. Incident cancer was associated with a substantially increased risk of death among those with HF (HR 1.56; 95 percent CI 1.22-1.99) after adjusting for age, gender, Charlson comorbidity index and other factors.

The authors suggest several possible explanations for the increased risk of cancer in HF patients, including side effects of cardiovascular treatments, or stress from illness or other mechanisms associated with the physiology of HF such as inflammation.

"The increased incidence of cancer among HF patients who already have an excess mortality underscores the importance of cancer surveillance in this population," they conclude. "These findings also illustrate the importance of multi-morbidity among patients living with chronic diseases and support the concept of providing holistic rather than disease-based care."

However, the authors also stress that more research is needed. "As the finding of an increased risk of cancer in HF is novel, studies will be needed to examine the mechanisms of this association," they add.

In an editorial comment, Anita Deswal, MD, MPH, FACC, and Sukhdeep S. Basra, MD, MPH, note that the findings should be interpreted with caution, and agree that further studies are warranted. "Temporal trends in the incidence of cancer in patients with HF should be investigated as should the effect of cancer surveillance on the diagnosis of cancer as well as the impact of cancer treatment on mortality in patients with HF," they note.

Keywords: Inflammation, Incidence, Risk, Neoplasms, Follow-Up Studies, Body Mass Index, Chronic Disease, Heart Failure, Comorbidity, Smoking, United States

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