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Mortality in Patients With Hodgkin Lymphoma and Heart Failure: A Swedish Population-Based Study
Sissel Johanne Godtfredsen1, Sandra Eloranta2, Karin E Smedby3
1Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Insights
Patients with classical Hodgkin lymphoma (cHL) and heart failure (HF) face higher overall mortality. Cardiovascular-specific mortality risk increases significantly 10 years post-cHL, suggesting potential late treatment effects.
Area of Science:
- Oncology
- Cardiology
- Epidemiology
Background:
- Individuals treated for classical Hodgkin lymphoma (cHL) exhibit an elevated risk of heart failure (HF).
- The impact of cHL on survival outcomes after HF diagnosis remains less understood.
Purpose of the Study:
- To compare all-cause mortality in patients with prior cHL who develop HF versus matched controls with HF.
- To explore cardiovascular (CV)-specific mortality as a secondary outcome.
Main Methods:
- A matched cohort study comparing 257 cHL patients with HF to 514 HF comparators (2:1 ratio).
- Matching criteria included sex, birth year, HF diagnosis year, and contact type.
- Flexible parametric survival models were used to estimate Hazard Ratios (HRs) with 95% Confidence Intervals (CIs).
Main Results:
- All-cause mortality was significantly higher in the cHL group (51% vs. 37%).
- Lymphoma-related deaths predominated in the cHL cohort (40%), while CV deaths were more common in comparators (42%).
- CV-specific mortality was similar overall but elevated for patients diagnosed with HF ≥10 years after cHL (HR: 3.13).
Conclusions:
- Prior cHL is associated with increased all-cause mortality post-HF diagnosis.
- A significantly higher CV-specific mortality risk was observed ≥10 years after cHL, potentially indicating late treatment toxicity.
- Careful interpretation is needed due to competing risks from lymphoma-related deaths.
Background:
While individuals treated for classical Hodgkin lymphoma (cHL) have an increased risk of heart failure (HF), the effect on survival is less clear.
Objectives:
The purpose of this study was to compare all-cause mortality following HF diagnosis between patients with prior cHL and comparators, with cardiovascular (CV)-specific mortality as an explorative outcome.
Methods:
Patients with cHL and subsequent HF were matched 1:2 with comparators with HF on sex, birth year, year of HF, and contact type (inpatient/outpatient). Follow-up began at HF and ended upon death or censoring (emigration; December 31, 2023; or maximum 5 years). HRs with 95% CIs were estimated using flexible parametric survival models adjusted for matching variables.
Results:
Between 2000 and 2022, 257 patients with cHL and 514 comparators were included. The median age was 73 years, and males predominated (64%). Over a median follow-up of 2.5 years for cHL and 3.3 years for comparators, respectively, 130 (51%) and 192 (37%) died. Lymphoma-related death dominated in the cHL group (40%), while CV death dominated among comparators (42%). All-cause mortality was higher for patients with HF and prior cHL than HF comparators (HR: 1.81; 95% CI: 1.44-2.26). CV-specific mortality did not differ overall (HR: 1.17; 95% CI: 0.78-1.75) except for patients with HF ≥10 years after cHL (HR: 3.13; 95% CI: 1.71-5.73).
Conclusions:
cHL was associated with higher all-cause mortality following HF diagnosis. CV-specific mortality was significantly higher for patients with HF ≥10 years after cHL, possibly highlighting the impact of late treatment toxicity, although careful interpretation is warranted given the strong competing risk of lymphoma-related deaths.
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