History of cancer and clinical outcomes in patients with recurrent acute heart failure; sub-analysis of the SAVIOR-L study

Background Heart failure (HF) and cancer frequently coexist, yet the prognostic impact of a history of cancer in patients with recurrent hospitalizations for acute HF remains incompletely understood. In particular, whether cancer history modifies outcomes according to HF severity and whether prognostic determinants differ by cancer status are unclear. Methods This post hoc analysis used data from the multicenter, prospective SAVIOR-L study, which enrolled patients hospitalized for acute HF exacerbation with at least one HF-related admission in the preceding year. Patients were stratified according to the presence or absence of a history of cancer. The primary endpoint was a composite of all-cause death and urgent rehospitalization. Kaplan–Meier analyses and Cox proportional hazards models were performed overall and stratified by N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels, using cut-offs of 900 and 1341 pg/mL consistent with the original study. Results Among 845 patients, 151 (17.9%) had a history of cancer. Overall, cancer history was not independently associated with all-cause mortality or the primary endpoint. Kaplan–Meier analyses showed comparable outcomes between groups. However, among patients with NT-proBNP ≥1341 pg/mL, those with a history of cancer had a significantly higher incidence of the primary endpoint, whereas no difference was observed in patients with lower NT-proBNP levels. In stratified stepwise analyses, prognostic determinants differed by cancer history: renal function and conventional HF markers predominated in patients without cancer history, whereas inflammatory, nutritional, and cardiopulmonary factors were more prominent in those with prior cancer. Conclusions In patients with recurrent hospitalizations for acute HF, a history of cancer was not an independent predictor of adverse outcomes overall. However, its prognostic relevance emerged in patients with advanced HF, as reflected by markedly elevated NT-proBNP levels. Distinct prognostic profiles according to cancer history underscore the need for integrated risk stratification incorporating inflammatory, nutritional, and frailty-related factors in HF patients with prior cancer.