Patterns and clinical outcomes of cardiovascular medication use after a cancer diagnosis in patients with heart failure

Date of Approval
Application Number
Technical Summary

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).

Health Outcomes to be Measured

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