Aims: Heart failure (HF) has been proposed as a potentially carcinogenic condition with earlier studies reporting conflicting results and recent analyses suggesting an increased cancer risk among HF patients. This study aims to assess cancer occurrence among cardiology inpatients with and without HF to clarify the HF-cancer relationship.
Methods and results: Among individuals aged 18-90 years with a first inpatient admission to Charité (2013-2021), no cancer documented prior to index date and at least 6 months follow-up, 7,069 individuals had HF, 8,709 did not. Two Cox regression models were applied: one simplified adjustment for age and sex, the second additionally for cardiovascular risk factors (CVRF) hypertension, diabetes and dyslipidemia. Sensitivity analyses excluded cases with cancer diagnosed within 90 days of the index date. A supplemental analysis was performed after excluding patients with less than 12 months of follow-up time.
Over a median follow-up of 33.4 months, 1,091 patients were diagnosed with cancer (7.3% HF vs. 6.6% non-HF; log-rank p=0.12). Multivariate analyses showed no apparent association between HF and cancer: simplified model hazard ratio (HR) 0.96 (95% Confidence Interval (CI) 0.85-1.08; p=0.5), and fully adjusted model including CVRFs HR 0.94 (95% CI 0.83-1.06; p=0.33). Sex-stratified analyses revealed no descriptive trend, though HRs differed in direction: men HR 0.91, women HR 1.02. Lung cancer was most prevalent in HF patients but indicated no notable trend. Only cancers of the male genital organs showed a potential, but inverse, association (HR 0.7).
Conclusions: Within a population of cardiology inpatients, we found no evidence of an increased cancer risk in HF patients.
