National Outcomes in Hospitalized Patients With Cancer and Comorbid Heart Failure

Heart failure (HF) and cancer are a significant cause of morbidity and mortality in the US. Due to overlapping risk factors, these two conditions often coexist.

We sought to describe the national burden of HF for hospitalized patients with cancer. We identified adults admitted with a primary oncologic diagnosis in 2014 included in the National Inpatient Sample (NIS). Patient hospitalizations were divided based on presence or absence of comorbid HF. Primary outcomes included cost, length of stay (LOS), and inpatient mortality. Logistic regression analysis with cluster adjustment was performed to determine predictors of inpatient mortality.

There were 834,900 admissions for a primary oncologic diagnosis in patients without comorbid HF, and 64,740 (7.2%) admissions for patients with comorbid HF. Patients with HF were on average older and had more comorbidities. Patients with HF had significantly higher mean hospitalization cost ($22,571 vs $20,234, p-value <0.001), age-standardized LOS (12.7 vs 8.2 days, p-value <0.001), and age-standardized inpatient mortality (12.2% vs 4.5%, p-value <0.001). Presence of HF predicted inpatient mortality after adjusting for age, race, insurance payer, and comorbidity index (OR 1.12, 95% CI 1.04-20, p-value = 0.002).

Patients with cancer hospitalized with comorbid HF represent a high-risk population with increased costs and high inpatient mortality rates. More data is needed to determine what screening and treatment measures may improve outcomes.