Identifying High-Risk Subgroups for Heart Failure Among People with Diabetes: The Impact of Cancer

The benefit of efforts to identify heart failure (HF) risk in cancer survivors is unclear. Individuals with diabetes mellitus (DM) are at elevated risk of both cancer and HF and may warrant further consideration regarding HF prevention.

To examine the incidence of HF in individuals with DM and cancer compared with DM alone.

A national cohort was established by linking the Australian National Diabetes Services Scheme (NDSS; n=792,742, aged ≥50 years) with hospital admissions, the National Death Index, and the Pharmaceutical Benefits Scheme. Cancer was defined by hospital admission or chemotherapy prescriptions. Incident HF was defined as the first HF hospitalization or HF-related death. Poisson models were adjusted for age, sex, socio-economic status, remoteness, coronary artery disease and hypertension.

Between 2010 and 2022, 31,082 HF events will occur during 6.3 million person-years. Among 143,111 individuals with DM and cancer, HF incidence per 1,000 person-years was 10.8 (95% CI 10.47-11.04) versus 4.4 (95% CI 4.37-4.47) with DM alone (IRR 1.52, 95% CI 1.48-1.57). Risk was highest in those ≥70 years with DM and cancer (10/1,000 person-years) and those with hematologic malignancies (19/1,000 person years). Compared to DM alone, cancer admission without chemotherapy carried greater HF risk (IRR 1.76, 95% CI 1.69-1.84) than did chemotherapy exposure (IRR 1.36 95% CI 1.31-1.42), suggesting cancer itself is associated with HF. Risk was strongest when cancer was coded as a secondary diagnosis, suggesting synergy with multimorbidity.

People with DM and cancer (especially aged ≥70 years), represent a high-risk group for HF.