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2019 HSR&D/QUERI National Conference Abstract

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4057 — The Impact of Cancer Survivorship on Mortality following Admission for Congestive Heart Failure

Lead/Presenter: Javad Razjouyan,  COIN - Houston
All Authors: Razjouyan J (COIN-Houston), Naik AD (VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA), Najafi B (Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA) Shahin J (VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA) Virani SS (VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA) Horstman MJ (VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA)

Objectives:
Lasting cardiovascular effects of cancer therapy may reduce cardiac compensatory reserve for acute clinical events. Limited data is available on the significance of cancer history on outcomes following acute cardiac events. The aim of this study is to examine the association between cancer survivorship and mortality following a hospital admission for heart failure.

Methods:
This is a retrospective cohort study in the Veterans Health Administration of patients admitted from 2012 to 2014 with a principal diagnosis of CHF. The exposure is a diagnosis of cancer from 1999 to the date of admission. We used a Cox hazard ratio (HR) to compare mortality. Covariates included age, gender, race, marital status, number of hospitalizations in the prior year, length of stay of the index admission and Charlson Comorbidity index. Age was stratified into four groups: age < 65, 65-75, 75-85, and ?85y. Time as a cancer survivor was stratified into quartiles based on the time from the first cancer diagnosis to the CHF admission.

Results:
The cohort consisted of 37,198 patients (age 71±11 years, male 98%) of which 8,920 had a cancer diagnosis. The average time as a cancer survivor was 69±51 months. Mortality was significantly higher following a CHF admission among cancer survivors (adjusted HR [aHR], 1.14, 95%CI 1.11-1.18). The aHR for mortality in cancer survivors compared to patients without a cancer diagnosis decreased as age increased (age < 65 : 1.25 [1.18,1.34]; age ? 85: 1.05[0.98-1.11]). Mortality was significantly higher for early cancer survivors ( < 23.15 months since diagnosis) in all age groups (aHR < 65 1.31[1.18,1.45], aHR 65-75 1.19[1.07,1.32], aHR 75-85 1.29[1.14,1.47], aHR ? 85 1.21[1.03,1.42]). For patients with the longest time as cancer survivors (? 110.64 months), mortality was significantly higher only in survivors that were less than 65 years of age (aHR 1.19 [1.06,1.33]).

Implications:
Cancer survivors have higher mortality rates following a CHF admission. As age and the time as a cancer survivor increases, the risk of mortality attributable to be a cancer survivor decreases.

Impacts:
Cancer survivorship is common in Veterans admitted for CHF and should be considered when planning interventions to reduce post-discharge mortality.