Characteristics and outcomes of patients with heart failure and history of malignancy: Data from Swedish Heart Failure Registry and the National Cancer Register.

AIMS Whether a history of malignancy affects heart failure (HF) management and prognosis is unclear. In HF randomized controlled trials, enrolment has been limited to patients with a cancer diagnosis at least 2 years before screening. We investigated clinical profile, HF treatment patterns, and outcomes of patients with a history of cancer of >2 years. METHODS AND RESULTS Among 53 314 patients included in the Swedish HF Registry between 2000 and 2020, 9066 (17%) had previous cancer (diagnosed >2 years prior to index date), most frequently of prostate (26%), breast (15%), colon (11%), and haematologic system (11%). Previous cancer was associated with older age, female sex, comorbidity burden, and less likely specialized follow-up. Over a median follow-up of 2.4 (0.0-5.0) years, mortality rates were 24 (95% confidence interval [CI] 23-25) and 18 (95% CI 18-19) per 100 subject-years in patients with versus without previous cancer, respectively. Cancer accounted for 16% of deaths in the previous cancer group and for 5.6% in the no-cancer group. Previous cancer was independently associated with higher risk of all-cause death (adjusted hazard ratio [HR] 1.14, 95% CI 1.11-1.18), non-cardiovascular death (adjusted HR 1.38, 95% CI 1.31-1.44), and first all-cause hospitalization (adjusted HR 1.11, 95% CI 1.09-1.14). The risk of non-cardiovascular death declined with increasing time from cancer diagnosis. In patients with HF and reduced ejection fraction (HFrEF), previous cancer was associated with less frequent use of mineralocorticoid receptor antagonists, triple pharmacotherapy, and HF devices. CONCLUSIONS Previous cancer was common among patients with HF, and it was associated with comorbidity burden, non-cardiovascular outcomes and, in HFrEF, with lower use of guideline-recommended therapies.