Heart failure mortality following cancer treatment: a linked health data analysis of blood, lymphatic and breast cancer patients (1996-2009)

Munir Chowdhury, Narelle Berry, Bogda Koczwara, Alexandra McCarthy, Shahid Ullah, John Atherton, David Roder, Robyn Clark

    Research output: Contribution to journalMeeting Abstract

    Abstract

    Background and introduction: Cardiotoxicity resulting in heart failure (HF) is a
    devastating complication of cancer treatment.
    Purpose: To describe the characteristics and time to death of blood, lymphatic
    and breast cancer patients who died of heart failure. Of those who died of heart
    failure two groups were compared, those who had an index hospital admission
    prior to death (HFA) and those who did not (NHFA).
    Methods: Three health data sets for the period of 1996–2009 including Queensland
    Cancer Registry (QCR), Death Registry and Hospital Administration records
    for HF and chemotherapy admissions were linked for this study. Index HF admission
    must have occurred after cancer diagnosis. Data were analysed by comparing
    demographic characteristics between HFA and NHFA patients and a multivariate
    Cox proportional hazards model was fitted to compare the survival outcomes
    between the two groups. A proportional hazard assumption was tested and confirmed
    to satisfy assumptions. Kaplan-Meier survival analysis was performed and
    groups were compared by log-rank test.
    Results: Within this cohort of 4894 patients, 734 were coded as HF related death
    (50.1% Female), 279 (38.0%) had at least one HF admission (41.9% Female) in
    the period of post cancer diagnosis. Median age of patients with HFA prior to
    death was 71 years (IQR 62–78) and 66 years (IQR 56–74) for NHFA. There
    were 72% HFA and 88% NHFA in the blood and lymphatic cancer group. Patients
    with HFA received fewer chemotherapy cycles (median=4, IQR 2–9) than
    the NHFA patients (median=6, IQR 2–12). Patients with an index HFA had 2.5
    times increased risk of HF mortality than NHFA patients (HR 2.50 [95% CI, 2.14–
    2.92] when adjusted for age, sex, marital status, country of birth, cancer site and
    number of chemotherapy doses). 31% of HFA and 33% of NHFA patients died
    of HF within one year and 60% and 62%, respectively, died within three years
    of commencement of cancer treatment. In addition 71% of the deceased cancer
    patients, who had an index HFA, died within one year of the index HF admission.
    Conclusion: In the first three years following cancer diagnosis a high proportion
    of patients died of HF following cancer treatment. Once diagnosed with HF
    almost three quarters of patients died within 12 months. Further research is underway by our team to explore the mechanisms underpinning these findings to help understand this high mortality.
    Original languageEnglish
    Article number4047
    Pages (from-to)682
    Number of pages1
    JournalEuropean Heart Journal
    Volume36
    Issue numberSuppl_1
    DOIs
    Publication statusPublished - 31 Aug 2015
    EventEuropean Society of Cardiology (ESC) Congress -
    Duration: 29 Aug 2015 → …

    Keywords

    • cancer patients
    • heart failure
    • mortality

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