Many patients in the UK suffer from heart conditions or cancer; sometimes patients can also have both. It is more difficult to treat patients living with both diseases. Patients with a heart condition called heart failure usually take several medications at the correct dosage to improve the symptoms. When patients have both cancer and heart failure, their medication management tends to be worsening
The purpose of this study is to understand 1) how does the heart failure medical therapy change after a patient has a cancer diagnosis; 2) how to predict the change in use of heart failure medicines in patients with both heart failure and cancer; and 3) how do different heart failure therapies affect patient hospitalisation risk and survival in patients with both heart failure and cancer.
The number of patients is increasing with cancer and heart disease, but there is little data on how these patients were treated. This research will raise awareness of this clinical issue and highlight the importance of maintaining medical treatment for heart failure after cancer.
Maintaining an optimal guideline-directed medical therapy (GDMT) for heart failure (HF) is essential for achieving the best possible clinical outcomes in patients with HF. Recent studies have suggested that patients with HF are at an elevated risk for cancer development. The aims of this study are to 1) determine the pattern of cardiovascular medication use before and after the cancer diagnosis in patients with pre-existing HF; 2) identify patient characteristics to predict changes in the GDMT medications; 3) investigate the association between the use of GDMT medications and the risk of hospitalisation for HF and mortality after the patient developed cancer.
We will conduct a retrospective cohort study using data between 1st January 2005 and 31st December 2020. The data sources will be CPRD GOLD and Aurum linked to HES data, ONS data, and Multiple Deprivation Index data.
We will first define a patient cohort with any new cancer diagnosis and pre-existing HF. For the first objective, we will describe the trend of use of GMDT medications after the cancer diagnosis, compared to the patterns before cancer diagnosis. The daily dose of the GMDT medications received by patients will be compared to the guideline recommendations. The time windows for the prescription trend description will be from six months before and six months after the cancer diagnosis. For the second objective, we will use multivariable logistic regression to find patient factors predicting the change in the use of GDMT medications. For the third objective, we will compare the mortality and hospitalisation risks among patients with different GDMT treatments. All patients will be followed from the cancer diagnosis until the outcome or censoring event or the end of the study. We plan to adjust for any confounding by inverse probability treatment weights (IPTWs) using the propensity score and marginal structural models (MSMs).
1) Proportion of patients using heart-failure-managing medications;
2) Mortality (all-cause, cardiovascular death and cancer-related death);
3) First hospitalisation for heart failure (HHF).
Chengsheng Ju - Chief Investigator - University College London ( UCL )
Li Wei - Corresponding Applicant - University College London ( UCL )
Charlotte Manisty - Collaborator - University College London ( UCL )
Pinkie Chambers - Collaborator - University College London ( UCL )
Wallis Lau - Collaborator - University College London ( UCL )
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation