Outcome and presentation of heart failure in breast cancer patients: Findings from a Swedish register-based study

Elham Hedayati, Antroula Papakonstantinou, Sofie A.M. Gernaat, Renske Altena, Judit S. Brand, Joakim Alfredsson, Nirmala Bhoo-Pathy, Jeorg Herrmann, Cecilia Linde, Ulf Dahlstrom, Jonas Bergh, Laila Hubbert

Research output: Contribution to journalArticlepeer-review


Aims: Heart failure (HF) patients diagnosed with breast cancer (BC) may have a higher risk of death, and different HF presentation and treatment than patients without BC. Methods and results: A total of 14 998 women with incident HF (iHF) or prevalent HF (pHF) enrolled in the Swedish HF Registry within and after 1 month since HF diagnosis, respectively, between 2008 and 2013. Patients were linked with the National Patient-, Cancer-, and Cause-of-Death Registry. Two hundred and ninety-four iHF and 338 pHF patients with BC were age-matched to 1470 iHF and 1690 pHF patients without BC. Comorbidity and treatment characteristics were compared using the χ2 tests for categories. Cox proportional hazard models assessed the hazard ratio (HR) and 95% confidence intervals (95% CIs) of all-cause and cardiovascular mortality among HF patients with and without BC. In the pHF group, BC patients had less often myocardial infarction (21.6% vs. 28.6%, P < 0.01) and received less often aspirin (47.6% vs. 55.1%, P = 0.01), coronary revascularization (11.8% vs. 16.2%, P < 0.01), or device therapy (0.9% vs. 3.0%, P = 0.03). After median follow-up of 2 years, risk of all-cause mortality (iHF: HR = 1.04, 95% CI = 0.83-1.29 and pHF: HR = 0.94, 95% CI = 0.79-1.12), cardiovascular mortality (iHF: HR = 0.94, 95% CI = 0.71-1.24 and pHF: HR = 0.89, 95% CI = 0.71-1.10), and HF mortality (iHF: HR = 0.80, 95% CI = 0.34-1.90 and pHF: HR = 0.75, 95% CI = 0.43-1.29) were similar for patients with and without BC in the iHF and pHF groups. Conclusion: Risk of all-cause and cardiovascular mortality in HF patients did not differ by BC status. Differences in pre-existing myocardial infarction and HF treatment among pHF patients with and without BC may suggest differences in pathogenesis of HF.

Original languageEnglish (US)
Pages (from-to)147-155
Number of pages9
JournalEuropean Heart Journal - Quality of Care and Clinical Outcomes
Issue number2
StatePublished - Apr 1 2020


  • Breast cancer
  • Clinical presentation
  • Epidemiology
  • Heart failure
  • Mortality

ASJC Scopus subject areas

  • Health Policy
  • Cardiology and Cardiovascular Medicine


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