HF Survival Rates Worse Than Those of Common Cancers, Including Bladder and Breast Cancer

Men and women with heart failure are more likely to die from their disease within 5 years than individuals with certain types of common cancers, including breast, prostate, and bladder cancer, a new study shows. But unlike cancer patients, heart failure patients still tend to be managed by primary care physicians rather than by specialists, an absurd situation that needs attention, experts say.

“I was really surprised the outcomes of heart failure in a contemporary cohort of patients were worse than some of the common cancers we see, particularly breast cancer in women,” said lead investigator Mamas Mamas, BMBCh (Keele University, Stoke-on-Trent, England). “Another important finding in our study is the issue of comorbid burden. Patients with heart failure are a very comorbid population—only 5% of heart failure patients don’t have a comorbidity whereas in cancer the burden is much less, with about 30% of patients having no other comorbidities.”

Results of the study were published May 3, 2017, in the European Journal of Heart Failure.

To TCTMD, Mamas said the tagline “heart failure is as malignant as cancer” is frequently mentioned at major cardiology meetings, but this dire prognosis is poorly understood outside heart failure circles. That’s despite the fact that the initial evidence suggesting that patients with a first admission for heart failure had a similar or worse survival rate than patients with certain cancers emerged more than two decades ago. For example, a 2001 analysis of 30,000 Scottish men and women suggested that heart failure was associated with worse long-term survival than many cancers, the exception being lung cancer.

Those study results have been repeated several times, most recently in a study of more than 1 million hospital admissions in Sweden.

“I think there’s a problem with these sorts of studies in that they’re relying on first-time hospital admissions,” said Mamas. “The reason that is problematic is that patients admitted with an acute heart failure syndrome are very sick whereas often cancer patients, at least in the era these studies were undertaken, were admitted for either staging procedures or investigations. They weren’t really acute. So you’re comparing apples and oranges and biasing the outcomes toward patients with heart failure.” 

Mamas noted that there has also been a “sea change” in the way heart failure patients are treated in the modern era, with aggressive medical therapy and the use of heart failure devices, all of which has served to reduce mortality.

‘As Malignant as Cancer’

To determine if heart failure was as malignant as cancer in the modern era, the researchers analyzed more than 56,600 men and women included in a Scottish primary care database. Overall, the 5-year survival rate for men with heart failure was 55.8%, which was significantly lower than the survival rates for men with prostate and bladder cancer (68.3% and 57.3%, respectively). For women with heart failure, the 5-year survival rate was 49.5%, which was lower than the survival rates among women with breast and colorectal cancer (77.7% and 51.5%, respectively).

In contrast, men with lung and colorectal cancer higher mortality rates than heart failure patients, while women with heart failure had better outcomes than those with lung and ovarian cancer.  

In a fully adjusted model, men with prostate and bladder cancer had a 39% and 12% lower risk of death, respectively, compared with men with heart failure. Similarly, women with breast cancer had a 45% lower risk of death compared with female heart failure patients.

On average, men and women with heart failure had 2.62 and 2.80 comorbid conditions, which was significantly more than patients with cancer. “We have a situation where we have a group of multi-morbid patients with heart failure, where despite all the advances in treatment, that still have really quite poor outcomes,” said Mamas.

There is still a lot of work to do in heart failure, including getting physicians to appreciate the severity of the prognosis and directing appropriate care to experts, according to the researchers. Mamas noted that in the United Kingdom, as well as the United States, heart failure patients are still frequently treated by primary care physicians even though there are data showing that patients managed by a dedicated heart failure clinic fare better than those who are not.

“It’s a crazy situation,” he said. “You couldn’t imagine somebody being diagnosed with cancer and being managed by their primary care doctor. They’d immediately be sent to secondary or tertiary care, or with referral to a specific cancer specialist who drives treatment. Yet patients with heart failure, who are elderly and have comorbid conditions, are often treated in the community. Some of these patients have never seen a cardiologist, let alone a heart failure specialist.”