Heart Failure and Cancer: New Insights into a Reciprocal Relationship and Emerging Treatment Approaches 

WASHINGTON, DC (OCTOBER 15, 2024) – A new Scientific Statement published by the Heart Failure Society of America (HFSA) has revealed a critical connection between heart failure (HF) and cancer, with shared mechanisms contributing to the incidence and progression of both diseases. Cardio-Oncology and Heart Failure: A Scientific Statement from the Heart Failure Society of America, published today in the Journal of Cardiac Failure (JCF), shows that patients with cancer are at increased risk of developing HF, while HF 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," said co-lead author Michelle Weisfelner Bloom, MD (Division of Cardiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY). 

Ana Barac, MD, PhD, co-lead author (Inova Schar Heart and Vascular, Inova Schar Cancer, Falls Church, Virginia) went on to add, “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. 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.” 

The Cardio-Oncology and Heart Failure: A Scientific Statement from the Heart Failure Society of America 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 HF 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 (LVAD) placements.  

As noted in the HF STATS 2024: Heart Failure Epidemiology and Outcomes Statistics An Updated 2024 Report from the Heart Failure Society of America paper, also published in JCF, the area of cardio-oncology, with systemic challenges such as delayed screenings and limited access to quality treatment, contributing to worse outcomes. This must be addressed to improve heart failure and cancer care.

The Cardio-Oncology and Heart Failure: A Scientific Statement from the Heart Failure Society of America is available online in the JCF at www.onlinejcf.com. DOI: 10.1016/j.cardfail.2024.08.045 

In addition to the statement, two supplemental articles have also been published: 

• Cardio-Oncology and Heart Failure: AL Amyloidosis for the Heart Failure Clinician A Supplement to the Scientific Statement from the Heart Failure Society of America DOI: 10.1016/j.cardfail.2024.08.046 
• Heart Failure in Patients with Cancer – A Patient’s Perspective DOI: 10.1016/j.cardfail.2024.08.047 

View all HFSA published scientific statements, guidelines and other clinical documents.

Top 10 Key Takeaways

1. HF 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 HF and patients with HF are at higher risk of developing cancer.
2. Beyond anthracyclines and HER2-targeted monoclonal antibodies, very few cancer therapeutics have standardized cardiac imaging surveillance recommendations, resulting in significant variations in clinical practices.  
3. 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.  
4. Heart failure with preserved ejection fraction (HFpEF) 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 (HSCT).  
5. 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. 
6. Durable left ventricular assist devices (LVADs) are feasible for patients with Stage D HF due to chemotherapy-induced cardiomyopathy, with similar survival rates compared to other causes of cardiomyopathy. 
7. 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. 
8. 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. 
9. Palliative care involvement is essential for enhancing the quality of life in patients with both cancer and HF, 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. 
10. 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.

About the Heart Failure Society of America
The Heart Failure Society of America, Inc. (HFSA) represents the first organized effort by heart failure experts from the Americas to provide a forum for all those interested in heart function, heart failure, and congestive heart failure (CHF) research and patient care. The mission of HFSA is to provide a platform to improve and expand heart failure care through collaboration, education, innovation, research, and advocacy. HFSA members include physicians, scientists, nurses, nurse practitioners, pharmacists, trainees, other healthcare workers and patients. For more information, visit hfsa.org.

About the Journal of Cardiac Failure
The Journal of Cardiac Failure (JCF) publishes the highest quality science in the field of heart failure with a focus on diversity, equity, and inclusion, mentorship, multidisciplinary partnerships, and patient-centeredness. Published papers span original investigator-initiated work to state-of-the-art reviews, guidelines and scientific statements, expert perspectives, early career and trainee spotlight pieces, patient and patient-partner narratives. JCF also emphasizes the power of language and prioritizes innovative approaches to dissemination of published work to reach and impact the broader heart failure community.

Media Contact: Laura Poko, 301-798-4493, ext. 226, [email protected]