Outcomes of patients with cancer admitted with heart failure-associated cardiogenic shock

Abstract

Aims: Acute decompensated heart failure (HF) can progress to cardiogenic shock, and patients with cancer are at an increased risk of HF compared with patients without cancer. However, limited data exist on outcomes of patients admitted for HF-related cardiogenic shock (HF-CS) with cancer vs. without cancer.

Methods and results: Adult patients admitted for HF-CS between 2014 and 2020 were identified using the National Readmission Database. Propensity score matching (PSM) was used to match 1 patient with cancer to 10 patients without cancer. Primary outcomes were in-hospital death, major bleeding, and thrombotic complications. Exploratory outcomes were 90-day readmission rates among patients who survived initial hospitalization. Temporal trends were also explored. Of the 137 316 admissions for HF-CS, 7306 (5.3%) had active cancer. After PSM, patients with cancer had increased odds of in-hospital death [odds ratio (OR) 1.12, 95% confidence interval (CI) 1.06-1.18], thrombotic complications (OR 1.12, 95% CI 1.03-1.21), and major bleeding (OR 1.23, 95% CI 1.17-1.31) compared with patients without cancer, with risks differing by cancer type. In exploratory analyses, rates of readmission were similar for patients with and without cancer. From 2014 to 2020, patients with cancer had no significant change in in-hospital mortality (Ptrend = 0.43), while patients without cancer had decreased mortality over time (Ptrend < 0.001).

Conclusion: Among patients admitted for HF-CS, patients with cancer are at increased risk of in-hospital death, thrombotic complications, and major bleeding compared with patients without cancer. Future studies are needed to guide nuanced evaluation and management of this population to improve outcomes.

Keywords: Cardio-oncology; Cardiogenic shock; Heart failure.