Increased cancer incidence in patients with pre-existing heart failure: results from a French nationwide cohort study

There is conflicting evidence as to whether patients with pre-existing heart failure (HF) are at increased risk of developing cancer, especially because of common risk factors. We aimed to assess the incidence of cancer in patients with pre-existing HF compared with patients without known HF. The French National Administrative Health Data System, containing all healthcare information for 99% of the French population, was used to identify adult patients with a first diagnosis of HF between 2010 and 2019 and without a history of cancer before HF diagnosis. HF patients were matched for sex and age to HF-free and cancer-free individuals (3:1 ratio). We found 330,867 HF patients, and 992,601 matched controls (54.7% women, mean age 77.7±13.5 years). A first cancer was diagnosed in 28,151 (8.5%) HF patients over a mean follow-up of 4.3±2.8 years compared to 77,325 (7.8%) in the controls over 4.9±2.8 years of follow-up (unadjusted subdistribution HR, sHR: 1.12 [1.11-1.13], P<0.001). The higher risk of new cancer in HF patients remained after full adjustment for major comorbidities, age, sex, year of diagnosis, region of residence, tobacco use and alcohol consumption (adjusted sHR=1.06, [1.04-1.07]; P<0.0001). Overall, the calculated attributable risk of new cancer after HF was 16.5% (9.9-16.8%). This increased risk was observed for most solid malignancies (especially colorectal and lung cancer), and for multiple myeloma. Patients with a history of HF have a higher risk of developing cancer than the general population. Cancer screening strategies should be advocated in patients with HF.