ArticleFrontiers in oncology2026
Cancer and the risk of death, heart-failure hospitalization, and major adverse cardiovascular events in HFpEF: a propensity-matched cohort study.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Cancer and heart failure with preserved ejection fraction (HFpEF) frequently coexist in older adults and may share pathobiology, yet the independent effect of cancer on clinical outcomes in HFpEF remains uncertain. Methods: We performed a single-center, retrospective cohort study using electronic health records from January 2020 through December 2024. Adults with HFpEF were stratified by a history of biopsy-proven or imaging-confirmed cancer. Primary outcomes were all-cause mortality, heart-failure hospitalization (HFH), and a composite of major adverse cardiovascular events (MACE: nonfatal myocardial infarction, HF rehospitalization, or arrhythmia requiring intervention). Secondary outcomes included change in New York Heart Association (NYHA) class, health status by Kansas City Cardiomyopathy Questionnaire (KCCQ), cause-specific mortality, and HFpEF-related health-care utilization. Propensity-score matching (PSM; 1:1 nearest-neighbor, caliper 0.2) balanced key covariates (age, sex, comorbidities, renal function, biomarkers, NYHA class, and LVEF). Time-to-event analyses used Kaplan-Meier methods and Cox proportional-hazards models with Greenwood 95% confidence bands and Schoenfeld diagnostics; prespecified subgroup analyses evaluated age, diabetes, chronic kidney disease (CKD), and NT-proBNP strata. Results: Of 403 eligible patients (cancer, 174; non-cancer, 229; median follow-up, 36 months), PSM yielded 306 patients (153 per group) with excellent covariate balance. In the matched cohort, cumulative incidences at 48 months were higher with cancer than without for all-cause mortality (31.4% Conclusions: In middle-aged and older adults with HFpEF, concomitant cancer confers a sustained and clinically meaningful increase in mortality, HF hospitalization, and major cardiovascular events independent of traditional risk factors and biomarkers. These data support systematic cardio-oncology collaboration, biomarker-guided surveillance, and proactive HFpEF management in patients with cancer.
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