Clinical evaluation and outcome in heart failure patients receiving chemotherapy with different anti-cancer agents

Abstract

Background: The optimal strategy for modern chemotherapy should be based on a comprehensive approach for cancer patients with cardiovascular diseases. Therefore, cardio-oncology has received increasing attention owing to the cardiotoxic effects of anti-cancer therapies.

Objectives: We aimed to evaluate the clinical characteristics and outcomes of patients with heart failure (HF) who received chemotherapy compared with those of a matched cohort with HF who did not receive chemotherapy, using real-world HF data.

Methods: This study was based on the Diagnosis Procedure Combination (DPC) database of the Japanese Registry of All Cardiac and Vascular Diseases (JROAD). We identified 1 328 113 patients who were hospitalized for HF between April 2012 and March 2021. The propensity score (PS) was estimated using a logistic regression model, with chemotherapy as the dependent variable, and a clinically score-matched analysis of 11 532 patients with HF with or without chemotherapy. The primary endpoint was readmission.

Results: Colon, lung, breast and prostate cancers accounted for >60% of all cancer types. After PS matching, readmission was significantly more frequently observed in patients with chemotherapy than those without [odds ratio (OR), 1.26; 95% confidence interval (CI) 1.17-1.36, P < 0.01]. In particular, treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) (OR, 1.69; 95% CI 1.39-2.07), taxane (OR, 2.95; 95% CI 2.11-4.12), anthracyclines (OR, 1.86; 95% CI 1.19-2.90) and fluorouracil agents (OR, 1.65; 95% CI 1.18-2.30) caused a higher risk of readmission.

Conclusions: Medical providers need to monitor and follow-up patients with HF, depending on the characteristics of the anti-cancer agents and types of cancer.

Keywords: cardio‐oncology; chemotherapy; heart failure; readmission.

Figure 1

Flowchart of this study. We included 1 328 113 patients hospitalized for heart failure. A total of 59 229 patients were diagnosed with cancer. A total of 5774 patients received chemotherapy, while 39 412 patients did not. JROAD‐DPC, Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination.

Figure 2

Proportion of cancer type among patients with heart failure during the first hospital admission and comparison with national statistics. Data are presented as each cancer proportion from the national statistics (%) and this study (%). Colon, lung, breast and prostate cancers accounted for more than 60% of all cancers. The proportions of prostate cancer, bladder cancer and leukaemia were two times higher than the national statistics. However, the proportion of stomach cancer was seven times lower than the national statistics.

Figure 3

Odds ratio of 1 year readmission in patients treated with each anti‐cancer drug compared with matched patients without chemotherapy. After propensity score matching, patients with heart failure who received chemotherapy such as epidermal growth factor receptor tyrosine kinase inhibitors (EGFR‐TKIs), Janus‐activated kinase (JAK) inhibitors, immunomodulatory drugs (IMiDs), fluorouracil agents, anthracyclines, taxanes, alkylating agents and endocrine therapy demonstrated a significant increase in 1 year readmission risk compared with matched patients who did not receive chemotherapy. ALK, anaplastic lymphoma kinase; Anti‐VEGF, anti‐vascular endothelial growth factor receptor; CI, confidence interval; CKD4/6, cyclin‐dependent kinase 4/6; GnRH, gonadotropin‐releasing hormone; HER2, human epidermal growth factor receptor 2; ICIs, immune checkpoint inhibitors; LHRH, luteinizing hormone‐releasing hormone; mTOR, mammalian target of rapamycin.