Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland

Aims: To evaluate whether the survival rates of patients with heart failure (HF) in the community are better than those with a diagnosis of the 4 most common cancers in men and women in a contemporary primary care cohort in Scotland.

Methods and Results: The data were obtained from the Primary Care Clinical Informatics Unit from a database of 1.75 million people registered with 393 general practices in Scotland. Sex-specific survival modeling was undertaken using Cox proportional hazards models, adjusted for potential confounders. A total of 56,658 patients were eligible to be included in the study with 147,938 person years follow up (median follow up 2.04 years). In men, heart failure (reference group; 5yrs survival 37.7%) had worse mortality outcomes than patients with prostate cancer (HR 0.61, 95%CI 0.57-0.65; 5yrs survival 49.0%), and bladder cancer (HR 0.88, 95%CI 0.81-0.96; 5yrs survival 36.5%), but better than lung cancer (HR 3.86, 95%CI 3.65-4.07; 5yrs survival 2.8%) and colorectal cancer (HR 1.23 95%CI 1.16-1.31; 5 yrs survival 25.9%). In women, patients with HF (reference group; 5yrs survival 31.9%) had worse mortality outcomes than patients with breast cancer (HR 0.55 95%CI 0.51-0.59; 5yrs survival 61.0%), but better outcomes than lung cancer (HR 3.82, 95%CI 3.60-4.05; 5yrs survival 3.6%), ovarian cancer (HR 1.98, 95%CI 1.80-2.17; 5yrs survival 19%) and colorectal cancer (HR 1.21, 95%CI 1.13-1.29; 5yrs survival 28.4%).

Conclusions: Despite advances in management, heart failure remains as ‘malignant’ as some of the common cancers in both men and women.