A new statement reveals that cancer patients face an increased risk of developing heart failure, while heart failure patients are more likely to develop cancer, highlighting the need for integrated care between cardiology and oncology.
Summary: A new scientific statement from the Heart Failure Society of America highlights a significant reciprocal relationship between heart failure and cancer, where cancer patients have a higher risk of developing heart failure, and heart failure patients face an increased risk of cancer. The statement, published in the Journal of Cardiac Failure, emphasizes the need for coordinated care between cardiology and oncology to manage shared risks and improve patient outcomes. It also calls for standardized cardiac imaging protocols during cancer therapies and addresses the concept of “permissive cardiotoxicity,” where some heart failure risk is accepted to maximize cancer treatment benefits.
Key Takeaways:
- Reciprocal Risk Between Cancer and Heart Failure: Cancer patients are at higher risk of developing heart failure, and heart failure patients are more likely to develop cancer, highlighting the interconnected nature of the two conditions.
- Need for Standardized Cardiac Imaging Protocols: The lack of uniform guidelines for cardiac imaging during cancer treatments leads to varied practices, increasing the risk of undetected heart failure in cancer patients.
- Balancing Cancer Treatment and Heart Failure Risk: The concept of “permissive cardiotoxicity” suggests that managing some degree of heart failure risk may be necessary to ensure effective cancer treatment, underscoring the need for cardiology-oncology collaboration.
A new scientific statement published by the Heart Failure Society of America (HFSA) has revealed a critical connection between heart failure and cancer, with shared mechanisms contributing to the incidence and progression of both diseases.
The statement, published today in the Journal of Cardiac Failure, shows that patients with cancer are at increased risk of developing heart failure, while heart failure patients face a higher risk of cancer, emphasizing the need for coordinated care between cardiology and oncology.
“We are only scratching the surface in the expanding field of cancer therapeutics. As we advance, it becomes clear that understanding the full spectrum of cardiac toxicities, including heart failure, is essential for maximizing treatment benefits and safeguarding patient heart health,” says co-lead author Michelle Bloom, MD, Leon H. Charney Division of Cardiology, NYU Langone Heart, NYU Grossman School of Medicine, in a release.
The scientific statement points out that more uniform guidelines are needed regarding standardized cardiac imaging protocols during cancer therapies to prevent heart-related complications.
More protocols are also needed regarding the notion of “permissive cardiotoxicity,” which acknowledges the need to balance some increased heart failure risk to ensure optimal cancer treatment. Careful assessment by heart failure specialists is crucial in cancer treatments including during risk assessments for heart transplantation and durable left ventricular assist device placements.
As noted in another paper also published in the Journal of Cardiac Failure, in the area of cardio-oncology, systemic challenges such as delayed screenings and limited access to quality treatment contribute to worse outcomes. This must be addressed to improve heart failure and cancer care.
Top 10 key takeaways from the scientific statement:
- Heart failure and cancer share common pathophysiological mechanisms for disease incidence and progression with evidence for reciprocal relationship. Patients with cancer are at increased risk for development of heart failure and patients with heart failure are at higher risk of developing cancer.
- Beyond anthracyclines and HER2-targeted monoclonal antibodies, very few cancer therapeutics have standardized cardiac imaging surveillance recommendations, resulting in significant variations in clinical practices.
- The concept of “permissive cardiotoxicity” highlights an emerging approach of maintaining lifesaving cancer therapies while accepting some degree of cardiac toxicity and mitigating risk through cardioprotective strategies.
- Heart failure with preserved ejection fraction is an important yet under-recognized aspect of cancer therapy-related cardiac toxicity, described in a wide array of cancer therapeutics including BTK inhibitors, CAR-T therapies, and hematopoietic stem cell transplantation.
- Cardiogenic shock in cancer patients can arise from various causes, including LV dysfunction due to cancer therapies, acute coronary syndrome, stress-induced cardiomyopathy, and immune checkpoint inhibitor-associated myocarditis.
- Durable left ventricular assist devices are feasible for patients with Stage D heart failure due to chemotherapy-induced cardiomyopathy, with similar survival rates compared to other causes of cardiomyopathy.
- For candidates with a history of cancer, careful and individualized risk assessment in collaboration with oncology specialists is crucial to determine eligibility for heart transplantation. This includes evaluating the impact of pre-existing neoplasms and the risk of cancer recurrence, with a personalized approach essential to prevent unnecessary delays in transplant listing.
- ICI-associated myocarditis should be recognized and treated urgently due to its severe nature and high mortality risk. Multidisciplinary care is crucial for accurate diagnosis and effective management, especially in hemodynamically unstable patients.
- Palliative care involvement is essential for enhancing the quality of life in patients with both cancer and heart failure and should be integrated early to manage symptoms, psychological stress, and care coordination. There is a growing push to integrate palliative care practices from oncology and cardiology to better support these patients, supported by clinical research and professional recommendations.
- Racial and ethnic minorities and LGBTQI+ populations experience significant health disparities in cancer and cardiovascular care due to systemic issues like delayed screenings and limited access to quality care. Strategies to address these inequities include community outreach, inclusive research, and improved access to care and clinical trials.
“Integrating heart failure clinicians into the care of cancer patients is crucial; their expertise ensures early detection and management of cardiac toxicity, ultimately enhancing patient outcomes and preserving quality of life,” says Ana Barac, MD, PhD, co-lead author, Inova Schar Heart and Vascular, Inova Schar Cancer, in a release. “This statement underscores the critical need for a multidisciplinary approach in managing heart failure among cancer patients, emphasizing that understanding the intersection of these two complex conditions is essential for improving patient outcomes and addressing disparities in care.”
