Division of Cardiology, UCLA Cardio-Oncology Program, David Geffen School of Medicine at UCLA, Los Angeles, California.
VA Greater Los Angeles Healthcare System, Los Angeles, California.
J Card Fail. 2019 Jul;25(7):516-521. doi: 10.1016/j.cardfail.2019.02.007. Epub 2019 Feb 12.
Heart failure (HF) and cancer are a significant cause of morbidity and mortality in the US. Due to overlapping risk factors, these two conditions often coexist.
We sought to describe the national burden of HF for hospitalized patients with cancer. We identified adults admitted with a primary oncologic diagnosis in 2014 included in the National Inpatient Sample (NIS). Patient hospitalizations were divided based on presence or absence of comorbid HF. Primary outcomes included cost, length of stay (LOS), and inpatient mortality. Logistic regression analysis with cluster adjustment was performed to determine predictors of inpatient mortality.
There were 834,900 admissions for a primary oncologic diagnosis in patients without comorbid HF, and 64,740 (7.2%) admissions for patients with comorbid HF. Patients with HF were on average older and had more comorbidities. Patients with HF had significantly higher mean hospitalization cost ($22,571 vs $20,234, p-value <0.001), age-standardized LOS (12.7 vs 8.2 days, p-value <0.001), and age-standardized inpatient mortality (12.2% vs 4.5%, p-value <0.001). Presence of HF predicted inpatient mortality after adjusting for age, race, insurance payer, and comorbidity index (OR 1.12, 95% CI 1.04-20, p-value = 0.002).
Patients with cancer hospitalized with comorbid HF represent a high-risk population with increased costs and high inpatient mortality rates. More data is needed to determine what screening and treatment measures may improve outcomes.
心力衰竭（HF）和癌症是美国发病率和死亡率的重要原因。由于存在重叠的危险因素，这两种疾病经常同时存在。
我们旨在描述患有癌症的住院患者中 HF 的全国负担。我们确定了 2014 年纳入国家住院患者样本（NIS）的患有主要肿瘤诊断的成年人。根据是否存在合并 HF，将患者的住院情况进行了分类。主要结局包括成本、住院时间（LOS）和住院内死亡率。采用带有聚类调整的逻辑回归分析来确定住院内死亡率的预测因素。
在无合并 HF 的患者中，有 834900 例因主要肿瘤诊断而入院，而有 64740 例（7.2%）因合并 HF 而入院。HF 患者的平均年龄较大，合并症更多。HF 患者的平均住院费用（$22571 与 $20234，p 值<0.001）、标准化 LOS（12.7 与 8.2 天，p 值<0.001）和标准化住院内死亡率（12.2%与 4.5%，p 值<0.001）均显著更高。在校正年龄、种族、保险支付人和合并症指数后，HF 的存在预测了住院内死亡率（OR 1.12，95%CI 1.04-20，p 值=0.002）。
患有癌症且合并 HF 的住院患者代表了一个高风险人群，其成本增加，住院内死亡率较高。需要更多的数据来确定哪些筛查和治疗措施可能改善结局。
