Research digest: The impact of cancer diagnosis on heart failure medical therapy use

6th September 2024

Following a cancer diagnosis, patients with heart failure with reduced ejection fraction (HFrEF) are less likely to continue or maintain the use of guideline-directed medical therapies (GDMTs), according to a new longitudinal study.

Researchers from University College London Hospitals NHS Foundation Trust analysed data from patients with heart failure in UK Clinical Practice Research Datalink between 2005 and 2021. Based on diagnostic and prescription records, patients with probable HFrEF were selected, and trends in the use and dosing of GDMTs before and after receiving a new cancer diagnosis were analysed.

The researchers matched 4,890 HFrEF patients with incident cancer to controls without cancer. The majority of the participants were male (73.9%), and the mean age was 75.7 years.

Patients with cancer were found to be 51% more likely to have poor adherence to renin-angiotensin-system inhibitors (RASIs), 22% more likely to have poor adherence to beta-blockers and 31% more likely to have poor adherence to mineralocorticoid receptor antagonists (MRAs) compared to non-cancer controls (RASIs: OR = 1.51, 95% CI = 1.35–1.68; beta-blockers: OR = 1.22, 95% CI = 1.08–1.37; MRAs: OR = 1.31, 95% CI = 1.08–1.59).

Cancer patients are also less likely to continue taking the GDMTs over time, with 104% more likely to stop taking RASIs, 35% more likely to stop taking beta-blockers and 49% more likely to stop taking MRAs than non-cancer controls.

Titration doses for RASIs and beta-blockers were more likely to be reduced after a cancer diagnosis (OR = 1.69, 95% CI = 1.40–2.04 and OR = 1.31, 95% CI = 1.05–1.62, respectively). None of the patients started new heart medications or had their medication doses increased after a cancer diagnosis, the researchers noted.

The reduction, interruption or cessation of heart failure treatments has a potentially negative impact on cardiovascular outcomes, the researchers said, adding that ‘this issue is even more concerning if the [heart failure] patient eventually needs cardiotoxic cancer treatments’.

Since heart failure leads to increased hospitalisation, and mortality is higher in patients with poor adherence or persistence to GDMTs, the researchers have called for better medical management of heart failure after a cancer diagnosis.

They also highlighted the need for further research, including targeted strategies for heart failure treatment optimisation, patient and clinician education at the time of cancer diagnosis, and an increase in multidisciplinary working between cardiologists, oncologists, general practitioners, pharmacists and specialist nurses.

Reference
Ju, C et al. Use of heart failure medical therapy before and after a cancer diagnosis: A longitudinal study, ESC Heart Failure 2024; Jul 23: doi.org/10.1002/ehf2.14981.

Higher CVD risk in patients with obstructive sleep apnoea taking beta-blockers

16th August 2023

The use of beta-blockers is associated with an increased risk of cardiovascular disease (CVD) and a trend for a higher mortality risk among patients with obstructive sleep apnoea (OSA), according to the findings from a recent study.

Researchers from University College London School of Pharmacy found that the use of beta-blocker drugs in patients with OSA increases the five-year risk of mortality and adverse cardiovascular outcomes.

In the absence of real-world evidence, the study, published in The Lancet Regional Health – Europe, investigated the impact of beta-blocker use on all-cause mortality and adverse cardiovascular outcomes in patients with OSA.

For the purposes of their analysis, the researchers turned to IQVIA Medical Research Data – a nationwide database of primary care records in the UK that contains around 6% of the total UK population in 2015. The database includes demographic and lifestyle information such as smoking and alcohol consumption, medical diagnoses and procedures, together with prescribing information.

Included patients were adults aged over 18 who had a diagnosis of OSA in their medical records. The team then compared the treatment strategies of initiating oral beta-blockers versus not starting a beta-blocker in these patients.

The outcomes of interest were all-cause mortality or a diagnosis of CVD, defined as a composite event of angina, myocardial infarction, stroke/transient ischaemic attack, heart failure or atrial fibrillation.

Beta-blocker usage in patients with OSA

A total of 37,581 patients met the eligibility criteria and were followed for a median of 4.1 years.

The five-year absolute risk of all-cause mortality and CVD outcomes were 4.9% and 13.0% among beta-blocker users, compared to 4.0% and 9.4% among non-beta-blocker users, respectively.

Commenting on these findings, study lead Dr Kenneth Man said: ‘Our study underscores the urgent need for further investigation into the relationship between beta-blockers and health outcomes in OSA patients.

‘Our hope is that this information will help medical professionals make more informed decisions when treating patients with OSA.‘

This extensive study is one of the few exploring the real-world implications of medical treatment in OSA patients. It emphasises the importance of careful and continued monitoring of these patients and encourages further investigation in this field.

Further studies are anticipated to confirm these findings and delve deeper into understanding the association between beta-blocker usage and patient outcomes. Until such studies are conducted, the medical community is urged to consider the potential risks highlighted by this research when treating patients with OSA.