Guideline-recommended medical therapy and clinical outcomes in cancer patients with de Novo heart failure

BACKGROUND AND AIMS: Heart failure (HF) may result from cancer therapy, yet data on guideline-recommended medical therapy (GRMT) in this setting remain limited. We aimed to describe the clinical course of de novo HF in cancer patients and assess GRMT use. METHODS: In this retrospective observational study, we screened all cancer patients diagnosed with de novo HF between January 2022 and December 2023. GRMT was defined as the use of beta-blockers, renin-angiotensin system inhibitors (RASi), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT2i). RESULTS: Seventy-one patients (mean age 51.6 ± 13.8 years; 22.5% male) were enrolled and followed for a median of 18 months. The median from cancer diagnosis to HF onset was 14 months. HF with reduced ejection fraction (HFrEF) was identified in 21 (29.8%), mildly reduced EF (HFmrEF) in 20 (28.2%), and preserved EF (HFpEF) in 30 (42.3%). Beta blocker use was 100% in both HFrEF/HFmrEF and 83.3% in HFpEF. Renin-angiotensin system inhibitors were prescribed in 95.2%, 100%, and 7%. MRA and SGLT2i were less frequently used, especially in HFpEF. LV recovery occurred in 15 (71.4%). De novo HF prompted treatment modification in 38 (53.5%) and dose reduction in 6 (8.5%). All-cause mortality was 25.4%; older age (HR:1.06) and male sex (HR:4.34) predicted mortality. CONCLUSIONS: While anthracycline or HER2-related HFrEF is the hallmark cardiotoxicity, HFpEF was the most common phenotype in this cohort. GRMT use was suboptimal in HFpEF, whereas LV recovery was frequent in HFrEF, supporting the potential benefit of optimal therapy. Prospective studies are needed to validate these findings.