Prognosis of acute coronary syndrome stratified by cancer type and status - a nationwide cohort study

Nouhravesh, Nina; Strange, Jarl Emanuel; Tønnesen, Jacob; Holt, Anders; Andersen, Camilla Fuchs; Jensen, Mads Hashiba; Al-Alak, Ali; D’Souza, Maria; Nielsen, Dorte Guldbrand; Kragholm, Kristian; Fosbøl, Emil Loldrup; Schou, Morten; Lamberts, Morten

doi:10.1016/j.ahj.2022.11.001

Cited by 8 publications

(11 citation statements)

References 23 publications

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“…The importance of granular data has become more evident in recent years, as the prevalence of cancer in patients with new-onset HF is rising, mainly driven by the increasing number of cancer survivors, as presented in this study in addition to others. 7,8,24 The line of therapy prescribed by clinicians relies on a risk stratification in which 1-year mortality is a key component. However, the lack of refined data on HF prognosis in patients with cancer has generated many clinical conundrums in an era that provides a range of new treatment possibilities.…”

Section: Discussionmentioning

confidence: 99%

“…6 However, there were no specific recommendations for management of HF in oncological patients, as investigations on cancer type, status, and prognosis were noted missing. 6 Recent studies have investigated cancer-specific, in-hospital morbidity and mortality in relation to myocardial infarction, which showed significant differences according to cancer type and status 7,8 ; however, such studies have not been conducted for new-onset HF. Hence, the aim of this study was to investigate the significance of major cancer types (breast cancer, gastrointestinal cancer, and lung cancer) and cancer status (i.e.…”

Section: Introductionmentioning

confidence: 99%

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Patient mortality following new‐onset heart failure stratified by cancer type and status

Nouhravesh

Strange

Holt

et al. 2023

European J of Heart Fail

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AimExpected 1‐year survival is essential to risk stratification of patients with heart failure (HF); however, little is known about the 1‐year prognosis of patients with HF and cancer. Thus, the objective was to investigate the 1‐year prognosis following new‐onset HF stratified by cancer status in patients with breast‐, gastrointestinal‐, or lung cancer.Methods and ResultsAll Danish patients with new‐onset HF from 2000–2018 were included. Cancer status was categorized as history of cancer (no cancer‐related contact within five years of HF diagnosis), non‐active cancer (curative intended procedure administered) and active cancer. Standardized 1‐year all‐cause mortality was reported using G‐computation. Age‐stratified 1‐year all‐cause mortality was estimated using the Kaplan–Meier estimator. In total, 193 359 patients with HF were included, 7.3% had either a breast‐, gastrointestinal or lung cancer diagnosis. Patients with cancer were older and more comorbid than patients without cancer. Standardized 1‐year all‐cause mortalities (95% confidence intervals) were 24.6% (23.0%–26.2%), 27.1% (25.5%–28.6%), and 29.9% (25.9%–34.0%) for history of breast‐, gastrointestinal‐, and lung cancer, which was comparable to patients with non‐active cancers. For active breast‐, gastrointestinal‐, and lung cancer, standardized 1‐year all‐cause mortalities were 36.2% (33.8%–38.6%), 49.0% (47.2%–50.9%), and 61.6% (59.7%–63.5%), respectively. One‐year all‐cause mortality increased incrementally with age, except for active lung cancer.ConclusionStandardized 1‐year all‐cause mortality were comparable for patients with history of cancer and non‐active cancer regardless cancer type, but varied comprehensively for active cancers. Prognostic impact of age was limited for active lung cancer. Thus, granular stratification of cancer is necessary for optimized management of new‐onset HF.This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient mortality following new‐onset heart failure stratified by cancer type and status

Nouhravesh

Strange

Holt

et al. 2023

European J of Heart Fail

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“…Notably, in-hospital mortality and surgical complications differ between patients with active cancer and patients with a history of cancer, 4 as does all-cause mortality. 5 No prior studies have assessed the validity of using administrative procedure codes to define active cancer. Previous studies have shown a high PPV regarding colorectal cancer diagnosis and registration in DNPR, 13 as well as cancer diagnosis in general.…”

Section: Discussionmentioning

confidence: 99%

“… 4 This emphasizes the need to differentiate between active cancer and historical cancer, when assessing the impact of cancer as a comorbidity. For example, the prognosis of acute coronary syndrome was recently found to vary with cancer type and cancer status 5 which could affect planned non-cancer treatments. We propose a procedure-based definition of active cancer and non-active cancer among patients with the three major cancer types: Breast-, lung- and colorectal cancer.…”

Section: Introductionmentioning

confidence: 99%

The Validity of a New Procedure-Based Definition of Cancer Status in Patients with Breast-, Lung- and Colorectal Cancer in the Danish National Patient Registry

Nielsen¹,

Nouhravesh²,

Jensen³

et al. 2023

CLEP

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Background/Aim: The Danish National Patient Registry (DNPR) provides unique epidemiological insight, but often lacks granular data. We propose a procedure-based definition of cancer status in patients with breast-, lung-and colorectal cancer, which can be applied to administrative health databases. New definitions of cancer status are needed as mortality and morbidity are closely linked to cancer status, yet most studies only use duration since cancer diagnosis as a severity marker. The aim of the study was to validate a new pragmatic definition. Methods: Medical journals of 600 patients, with breast-, lung-and colorectal cancer from the Department of Oncology at Herlev-Gentofte Hospital were retrospectively reviewed. We defined active cancer as a cancer diagnosis, not followed by a potentially curative procedure within 6 months of the diagnosis. The remaining patients were characterized as having non-active cancer. This dichotomization was then compared to a cancer status assessment based on treatment received and paraclinical test such as their first postprocedural control scan. Based on this comparison, we calculated the positive predictive value (PPV) of our definitions of active and non-active cancer. Results: The calculated PPVs for active breast-, lung-and colorectal cancer were 87% (CI 95%: 0.74-0.99), 91% (CI 95%: 0.87-0.96) and 82% (CI 95%: 0.73-0.91). The PPVs for non-active breast-, lung-and colorectal cancer were 95% (CI 95%: 0.92-0.99), 91% (CI 95%: 0.82-0.99) and 73% (CI 95%: 0.66-0.81), respectively. Conclusion:We found an overall high PPV for both active and non-active cancer across all three types of cancer.

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“…This gap of evidence is addressed by a research article by Nouhravesh et al 5 . in this issue of the Journal.…”

Section: Figurementioning

confidence: 98%

When and how? Two simple questions to determine cancer status and inform therapeutic decisions and trial design in heart failure

Ameri,

Vaduganathan

2023

European J of Heart Fail

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Prognosis of acute coronary syndrome stratified by cancer type and status - a nationwide cohort study

Cited by 8 publications

References 23 publications

Patient mortality following new‐onset heart failure stratified by cancer type and status

Patient mortality following new‐onset heart failure stratified by cancer type and status

The Validity of a New Procedure-Based Definition of Cancer Status in Patients with Breast-, Lung- and Colorectal Cancer in the Danish National Patient Registry

When and how? Two simple questions to determine cancer status and inform therapeutic decisions and trial design in heart failure

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