Cancer development and mortality in a real-world cohort of patients hospitalized with acute heart failure in a community hospital in a country of South America

Background Heart Failure and cancer are the two most important health burdens globally. Nowadays, evidence supports a bidirectional relationship between them. Purpose To evaluate new cancer development in patients hospitalized with the first episode of acute heart failure, mortality and clinical implications. Methods We performed an observational, prospective study of 570 consecutive patients admitted with a diagnosis of acute heart failure in a coronary unit affiliated to a community hospital. The entire database ncluded 181 demographic, previous history, lab tests, cardiovascular imaging, treatment and follow-up variables. The follow-up was done 100%. Categorical variables were expressed as percentages and compared using the chi-square test and numerical variables with the Mann-Whitney-Wilcoxon test. Survival during follow-up was compared with the log-rank test. Results The mean age was 79 ± 11 years and 329 (58%) were male. Ischemic-necrotic cause of heart failure was 35.5% and mean left ventricular ejection fraction was 45% (interquartile range 25-75 14-60). Pre-existing cancer was detected in 111 patients (19,4%). Prevalence of hypertension was 90.3%, dyslipidemia 53%, smoking 36% and diabetes mellitus 21, 7%.There were no demographic differences or differences in cardiovascular risk factors. During follow-up, 48 (8.4%) new cases of cancer were diagnosed and 9 (18.75%) of them were the second episode in the patient. Of those with heart failure and Cancer (total), 53% died from heart failure, 25% from cancer and 22% from other causes. Those with heart failure and total cancer vs heart failure without cancer had less coronary history 35% vs 53% p 0.005, dementia 2.2% vs 10% p 0.004 and previous treatment with ACEI: 23% vs 33% p 0.02. There were no differences in mortality in the follow-up between those who had or did not have cancer, log-rank test chi square 1.3 p NS. While they had a higher prevalence of previous alcoholism 21% vs 0.5% p:0001 and previous anaemia 23% vs 13% p 0.01. Conclusions In our cohort, cancer was not associated with increased mortality during follow-up. However, there are significant differences in comorbidities, such as a lower prevalence of coronary heart disease and a higher prevalence of alcoholism and anaemia in patients with heart failure and cancer. These findings highlight the need for a comprehensive approach to the management of this population, considering their multiple comorbidities to optimize their follow-up.