Prognoses of “high-profile” diseases: five-year survival following hospitalization with previous cancer compared to previous heart failure

The prognostic impact of heart failure relative to that of “high-profile” disease states such as cancer within the whole population is poorly known. Some data reported 2 decades ago indicated that heart failure was as “malignant” as many common types of cancer (with the notable exception of lung cancer) and was associated with a comparable number of expected life-years lost. Whether this is also the case in more recent years is unknown.

In a nationwide cohort study including 5,123,193 patients seen in French hospitals in 2012 with at least 5 years of follow-up (or dying earlier), all patients with a first admission to any hospital with heart failure or cancer were identified. We assessed the incidence of all-cause death during follow-up (2,523,627person-years). We analysed the outcome for the most common types of cancer specific to men and women and the results were then age-adjusted in men and in women.

In 2012, 409,210 men had a hospitalisation with heart failure (n=164,601) or cancer (n=244,609). Similarly, 325,410 women were admitted with heart failure (n=127,734), or cancer (n=197,676).

Heart failure was associated with a worse survival rate than urologic cancer in men and a worse survival rate than breast cancer, gynaecologic cancer and gastrointestinal cancer in women (Figure 1). On an age-adjusted basis, cancer was associated with a worse survival than heart failure in men except for urologic cancer (see adjusted hazard ratios in Table 1). Cancer was associated with a worse age-adjusted survival than heart failure in women except for breast cancer.

Heart failure may be as “malignant” as many common types of cancer in men and in women. However, it is possible that the prognosis of HF has improved compared to that of cancer in the 2 last decades since only breast cancer in women and urologic cancer in men had a better prognosis than heart failure in an age-adjusted analysis.

Type of funding sources: None.