Breast cancer and heart failure: don’t let the statistics get in the way of the facts

Breast cancer and heart failure: don't let the statistics get in the way of the facts H eart failure is a malignant condition with a worse prognosis than for many cancers, including breast cancer in women. 1 Patients with heart failure may be at increased risk of developing some cancers, including breast cancer, even after adjusting for shared risk factors, including obesity and smoking, or comorbid conditions, such as chronic lung disease. 2,3A growing body of evidence suggests that cancer and heart failure not only share common risk factors but also share common cellular and molecular mechanisms such as systemic inflammation, metabolic remodeling, clonal hematopoiesis, angiogenesis, and stromal cell signaling. 4 Conversely, patients with cancer may be more likely to develop heart failure, as might be expected if they share risk factors and have common comorbidities.Treatments for cancer may also cause myocardial, vascular, and renal damage and anemia, which may cause or exacerbate preexisting heart failure. 5Cancer-induced cachexia may also cause atrophy of skeletal muscles and myocardium (cardiac wasting), which could also cause or exacerbate heart failure. 6,7 Patients with cancer and heart failure generally have a worse prognosis than those with either condition alone, and the existence of one often complicates the management of the other. 4 In this issue of BUMC Proceedings, Obeidat and colleagues explored the impact of breast cancer on in-hospital mortality and health care utilization in women with heart failure. 8They acquired data from the US National Inpatient Sample (NIS) and, using a propensity-matched analysis, compared outcomes for almost 90,000 women with heart failure and breast cancer compared with a similar number of women with heart failure but without breast cancer.Most patients were Caucasian, the mean age was 73 years, 42% had diabetes, and about 40% had a history of myocardial infarction.Most patients were insured through Medicare (72%) and about 11% had private insurance.The investigators report that women with heart failure and breast cancer, especially if it was metastatic, were more likely to die during hospitalization, experienced longer hospital stays, and incurred higher hospital costs.This is important but hardly surprising.Patients with "isolated diastolic" heart failure (about 45% of the cohort), which might otherwise be described as heart failure with preserved ejection fraction (HFpEF), had a substantially higher inpatient mortality if they had