Comparison of heart failure risk assessment tools among cancer survivors

Area of Science:

• Cardio-oncology
• Cardiovascular disease epidemiology
• Cancer survivorship

Background:

• Cancer survivors face elevated heart failure (HF) risk due to shared risk factors and cardiotoxic cancer treatments.
• Effective HF screening relies on accurate risk assessment, but optimal methods for survivors remain unclear.
• This study compares the performance of existing HF risk calculators in cancer survivor populations.

Purpose of the Study:

• To evaluate and compare the predictive accuracy of three HF risk calculators in cancer survivors.
• To identify the most effective risk assessment tool for stratifying HF risk in this population.
• To inform the development of targeted HF prevention strategies for cancer survivors.

Main Methods:

• Utilized UK Biobank data, identifying cancer survivors and non-cancer controls via ICD-10 codes.
• Assessed incident HF risk using the Heart Failure Association-International Cardio-oncology Society (HFA-ICOS), Atherosclerosis Risk in Communities (ARIC-HF), and Pooled Cohort Equations to Prevent Heart Failure (PCP-HF) scores.
• Compared predictive performance using the area under the curve (AUC) after propensity matching for age and sex.

Main Results:

• HFA-ICOS (AUC 0.753) and ARIC-HF (AUC 0.757) demonstrated similar and superior discrimination for incident HF compared to PCP-HF (AUC 0.717).
• All tested risk calculators showed better performance in survivors of cancer types other than breast cancer or lymphoma.
• The study included 9,232 breast cancer/lymphoma survivors and 23,800 survivors of other cancer types.

Conclusions:

• HFA-ICOS and ARIC-HF risk calculators outperformed PCP-HF in predicting incident HF among cancer survivors and controls.
• While all models showed modest discrimination, a cancer-specific HF prediction tool could enhance prevention efforts.
• Optimizing HF risk assessment is crucial for proactive cardiovascular care in cancer survivors.