Federated cohort study (TriNetX) of 120,783 HF patients and 7,896 AMI patients propensity-matched 1:1 to controls without HF/AMI, excluding prior/concurrent cancer. New cancer diagnoses starting 6 months after index hospitalization showed strikingly elevated risk: HF HR 2.80 (95% CI 2.69–2.91); AMI HR 2.02 (95% CI 1.71–2.39); both p<0.001. The excess risk was much greater for haematologic malignancies (HF HR 6.78; AMI HR 4.45) than solid tumours. HFpEF carried slightly higher cancer incidence than HFrEF/HFmrEF (HR 1.10). Hypothesis-generating finding in 'reverse cardio-oncology' — possible mechanisms include shared inflammatory pathways and clonal haematopoiesis. Prospective confirmation needed before screening implications.
Heart failure (HF) and acute myocardial infarction (AMI) may contribute to cancer development through shared and disease-related pathophysiological pathways. We investigated the mid-term risk of incident cancer in patients with HF or AMI using a large, real-world dataset.
Adults with a first hospitalization for acute HF or AMI between October 2015 and October 2024 were included from the TriNetX Global Collaborative Research Network. Patients with prior or concurrent cancer were excluded. Each cohort was matched 1:1 with controls without HF or AMI using propensity score matching. The primary end-point was any new cancer diagnosis occurring during follow-up, starting 6 months after the index hospitalization.
After matching, 120,783 patients with HF and 7,896 patients with AMI were included. Over a median follow-up of 13 months in the HF cohort and 16 months in the AMI cohort (after the 6-month landmark), both groups showed a higher incidence of cancer compared with controls (HF: HR 2.80, 95% CI 2.69–2.91; AMI: HR 2.02, 95% CI 1.71–2.39; both p<0.001). In both cohorts, the excess risk was more pronounced for haematologic than for solid malignancies (HF: HR 6.78 vs 2.53; AMI: HR 4.45 vs 1.77). HFpEF was associated with a slightly higher cancer incidence than HFrEF/HFmrEF (HR 1.10; 95% CI 1.04–1.17; p=0.002), whereas no difference was observed between ST and non-ST segment elevation AMI.
In this large, real-world cohort, both HF and AMI were associated with an increased incidence of cancer, particularly haematologic malignancies. HF was associated with a greater excess risk than AMI. These findings are hypothesis-generating and warrant further investigation into shared pathways and screening implications.
