Introduction: Recent reports have suggested a higher risk of incident cancer among patients with pre-existing Heart failure (HF) in community-based cohorts.
Methods: To investigate the association between heart failure (HF) during hospitalization with acute coronary syndrome (ACS) and the very long-term cancer risk, we enrolled 572 patients admitted with ACS to 3 Italian hospitals and discharged alive and free from neoplasia. Patients were prospectively followed for 24 years or until death.
Results: All except for three patients completed the follow-up, representing 6440 person-years. Patients' mean age was 66 ± 12 years and 70% were males. Baseline clinical HF was diagnosed in 192 (34%) patients. During follow-up, 129 patients (23%) developed cancer; of them, 103 with no HF [27% of patients without HF] and 26 had baseline HF [14% of patients with HF].
The incidence rates for cancer were 18 and 21 per 1000 person-years for patients with and without baseline HF, respectively (p = 0.62).
The risks for cancer associated with HF were (HR: 0.96; 95% CI: 0.62-1.47; p=0.85). Similar associations were observed among both genders and in patients younger than 75 years of age. Yet, in patients older than 75 years, the unadjusted risk was (HR: 0.30; 95% CI: 0.09-0.92; p=0.04). However, the fully adjusted risk was (HR: 0.39; 95% CI: 0.12-1.30; p=0.13). The unadjusted HRs for incident cancer were (HR: 0.88; 95% CI: 0.45-1.74; p=0.73) and (HR: 0.91; 95% CI: 0.48-1.71; p=0.77) for patients with HFrEF and HFpEF respectively.
We observed a positive interaction between age and LVEF for the risk of cancer onset (HR: 1.002; 95% CI: 1.003 -1.004; p=0.02) in the unadjusted model. Results were the same in the fully adjusted model.
Conclusions: A lack of association between clinical HF at admission for ACS and the long-term cancer risk has been observed in this prospective study of unselected ACS patients. A positive independent interaction between age and LVEF has been also observed.