Comparison of heart failure risk assessment tools among cancer survivors

Abstract

Background: Cancer survivors have an increased risk of incident heart failure (HF) attributable to shared risk factors and cancer treatment-induced cardiac dysfunction. Selection for HF screening depends on risk assessment, but the optimal means of assessing risk is undefined. We undertook a comparison of HF risk calculators among survivors.

Methods: In this study from the UK Biobank, cancer and HF diagnoses were determined based on the International Classification of Diseases (ICD)-10 code and non-cancer participants were included as controls. Participants' risk of incident HF was determined using the Heart Failure Association-International Cardio-oncology Society (HFA-ICOS), the Atherosclerosis Risk in Communities (ARIC-HF) and the Pooled Cohort Equations to Prevent Heart Failure (PCP-HF). The predictive performances of each were compared using the area under the curve (AUC).

Results: After propensity matching with age and sex, 9,232 survivors from breast cancer or lymphoma (mean age 59.9 years, 87.8% female), and 23,800 survivors from other cancer types (mean age 59.1 years, 85.8% female) were included in the analysis. The discriminative value for HFA-ICOS (AUC 0.753 [95%CI: 0.739-0.766]) and ARIC-HF (0.757 [95%CI: 0.744-0.770]) were similar, and superior to PCP-HF (0.717 [95%CI: 0.702-0.732]). The overall performance for each risk score was better among participants in other cancer types than those with breast cancer and lymphoma.

Conclusions: HFA-ICOS and ARIC-HF outperformed the PCP-HF among cancer- and non-cancer cohort, although all showed modest discrimination for incident HF to be applied to clinical practice. A cancer-specific HF prediction tool could facilitate HF prevention among survivors.

Keywords: Cancer; Heart failure; Prognosis; Risk assessment.

Fig. 1

The cumulative incidence plot of heart failure among UK Biobank participants

Fig. 2

The cumulative incidence plot of heart failure among cancer survivors, stratified according to age range

Fig. 3

The receiver operating characteristics curve for each CVD risk assessment tool in predicting heart failure incidence. CVD: Cardiovascular disease; ARIC-HF: Atherosclerosis Risk in Communities – Heart Failure; PCP-HF: Pooled Cohort Equations to Prevent Heart Failure; HFA-ICOS: Cardio-Oncology Risk Assessment.