An analysis of heart failure among cancer patients in the United States between 1999 and 2020.

Background: Cancer and heart failure (HF) are highly prevalent in the population and can co-exist, due to shared risk factors and an aging population. The HF-related mortality burden in cancer patients across in the United States (US) remains poorly understood. The goal of this study is to evaluate the patterns of HF-related deaths among cancer patients in the United States. Methods: A retrospective analysis was performed using the Centers for Disease Control and Prevention (CDC) WONDER Multiple Cause of Death database between years 1999 and 2020. HF-related deaths were defined as death certificates listing HF as a contributing cause of death, while HF-specific deaths were defined as those with HF listed as the underlying cause of death. The ten most common malignancies in the US were analyzed. Mortality rates, temporal trends, regional differences, sex- and race-based disparities were evaluated. Results: A total of 402,308 HF-related deaths were identified among patients with the ten most common cancers. Lung cancer was associated with the highest rates, accounting for 115,283 deaths (1.71 per 100,000 population), followed by prostate cancer (1.08 per 100,000), colorectal cancer (0.90 per 100,000) and breast cancer (0.84 per 100,000). Most malignancies had increasing HF-related mortality during the latter years of the study period. The Midwest had the highest HF-related mortality rates for several types of cancer. White patients had the highest HF-related mortality rates across all cancer types. Among HF-specific deaths, prostate cancer exhibited the highest mortality rate (594.03 per 100,000). Conclusions: There is a substantial HF-related mortality burden across cancer patients, which is on the rise in recent years. Certain high-risk populations may be identified and cardio-oncology surveillance and targeted cardiovascular risk reduction strategies may be implemented among cancer survivors.