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

Mamas A Mamas (Corresponding Author), Matthew Sperrin, Margaret C. Watson, Alasdair Coutts, Katie Wilde, Christopher Burton, Umesh T. Kadam, Chun Shing Kwok, Allan B Clark, Peter Murchie, Iain Buchan, Philip C Hannaford, Phyo K Myint

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Abstract

Aims
This study was designed to evaluate whether survival rates in patients with heart failure (HF) are better than those in patients with diagnoses of the four most common cancers in men and women, respectively, in a contemporary primary care cohort in the community in Scotland.

Methods and results
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 modelling was undertaken using Cox proportional hazards models, adjusted for potential confounders. A total of 56 658 subjects were eligible for inclusion in the study. These represented a total of 147 938 person-years of follow-up (median follow-up: 2.04 years). In men, HF (reference group; 5-year survival: 55.8%) had worse mortality outcomes than prostate cancer [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.57–0.65; 5-year survival: 68.3%], and bladder cancer (HR 0.88, 95% CI 0.81–0.96; 5-year survival: 57.3%), but better outcomes than lung cancer (HR 3.86, 95% CI 3.65–4.07; 5-year survival: 8.4%) and colorectal cancer (HR 1.23, 95% CI 1.16–1.31; 5-year survival: 48.9%). In women, HF (reference group; 5-year survival: 49.5%) had worse mortality outcomes than breast cancer (HR 0.55, 95% CI 0.51–0.59; 5-year survival 77.7%), but better outcomes than colorectal cancer (HR 1.21, 95% CI 1.13–1.29; 5-year survival 51.5%), lung cancer (HR 3.82, 95% CI 3.60–4.05; 5-year survival 10.4%), and ovarian cancer (HR 1.98, 95% CI 1.80–2.17; 5-year survival 38.2%).

Conclusions
Despite advances in management, HF remains as ‘malignant’ as some of the common cancers in both men and women.
Original languageEnglish
Pages (from-to)1095-1104
Number of pages10
JournalEuropean Journal of Heart Failure
Volume19
Issue number9
Early online date3 May 2017
DOIs
Publication statusPublished - Sep 2017

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Scotland
Primary Health Care
Cohort Studies
Heart Failure
Survival
Confidence Intervals
Neoplasms
Colorectal Neoplasms
Lung Neoplasms
Medical Informatics
Mortality
Proportional Hazards Models
Urinary Bladder Neoplasms
General Practice
Ovarian Neoplasms
Prostatic Neoplasms
Survival Rate
Databases
Breast Neoplasms

Keywords

  • heart failure
  • cancer
  • mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland. / Mamas, Mamas A (Corresponding Author); Sperrin, Matthew; Watson, Margaret C.; Coutts, Alasdair; Wilde, Katie; Burton, Christopher; Kadam, Umesh T. ; Kwok, Chun Shing; Clark, Allan B; Murchie, Peter; Buchan, Iain; Hannaford, Philip C; Myint, Phyo K.

In: European Journal of Heart Failure, Vol. 19, No. 9, 09.2017, p. 1095-1104.

Research output: Contribution to journalArticle

Mamas, Mamas A ; Sperrin, Matthew ; Watson, Margaret C. ; Coutts, Alasdair ; Wilde, Katie ; Burton, Christopher ; Kadam, Umesh T. ; Kwok, Chun Shing ; Clark, Allan B ; Murchie, Peter ; Buchan, Iain ; Hannaford, Philip C ; Myint, Phyo K. / Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland. In: European Journal of Heart Failure. 2017 ; Vol. 19, No. 9. pp. 1095-1104.
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title = "Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland",
abstract = "AimsThis study was designed to evaluate whether survival rates in patients with heart failure (HF) are better than those in patients with diagnoses of the four most common cancers in men and women, respectively, in a contemporary primary care cohort in the community in Scotland.Methods and resultsData 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 modelling was undertaken using Cox proportional hazards models, adjusted for potential confounders. A total of 56 658 subjects were eligible for inclusion in the study. These represented a total of 147 938 person-years of follow-up (median follow-up: 2.04 years). In men, HF (reference group; 5-year survival: 55.8{\%}) had worse mortality outcomes than prostate cancer [hazard ratio (HR) 0.61, 95{\%} confidence interval (CI) 0.57–0.65; 5-year survival: 68.3{\%}], and bladder cancer (HR 0.88, 95{\%} CI 0.81–0.96; 5-year survival: 57.3{\%}), but better outcomes than lung cancer (HR 3.86, 95{\%} CI 3.65–4.07; 5-year survival: 8.4{\%}) and colorectal cancer (HR 1.23, 95{\%} CI 1.16–1.31; 5-year survival: 48.9{\%}). In women, HF (reference group; 5-year survival: 49.5{\%}) had worse mortality outcomes than breast cancer (HR 0.55, 95{\%} CI 0.51–0.59; 5-year survival 77.7{\%}), but better outcomes than colorectal cancer (HR 1.21, 95{\%} CI 1.13–1.29; 5-year survival 51.5{\%}), lung cancer (HR 3.82, 95{\%} CI 3.60–4.05; 5-year survival 10.4{\%}), and ovarian cancer (HR 1.98, 95{\%} CI 1.80–2.17; 5-year survival 38.2{\%}).ConclusionsDespite advances in management, HF remains as ‘malignant’ as some of the common cancers in both men and women.",
keywords = "heart failure, cancer, mortality",
author = "Mamas, {Mamas A} and Matthew Sperrin and Watson, {Margaret C.} and Alasdair Coutts and Katie Wilde and Christopher Burton and Kadam, {Umesh T.} and Kwok, {Chun Shing} and Clark, {Allan B} and Peter Murchie and Iain Buchan and Hannaford, {Philip C} and Myint, {Phyo K}",
note = "MS and IB were supported by the University of Manchester's Health eResearch Centre (HeRC) funded by the Medical Research Council (MRC) Grant MR/K006665/1.",
year = "2017",
month = "9",
doi = "10.1002/ejhf.822",
language = "English",
volume = "19",
pages = "1095--1104",
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TY - JOUR

T1 - Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland

AU - Mamas, Mamas A

AU - Sperrin, Matthew

AU - Watson, Margaret C.

AU - Coutts, Alasdair

AU - Wilde, Katie

AU - Burton, Christopher

AU - Kadam, Umesh T.

AU - Kwok, Chun Shing

AU - Clark, Allan B

AU - Murchie, Peter

AU - Buchan, Iain

AU - Hannaford, Philip C

AU - Myint, Phyo K

N1 - MS and IB were supported by the University of Manchester's Health eResearch Centre (HeRC) funded by the Medical Research Council (MRC) Grant MR/K006665/1.

PY - 2017/9

Y1 - 2017/9

N2 - AimsThis study was designed to evaluate whether survival rates in patients with heart failure (HF) are better than those in patients with diagnoses of the four most common cancers in men and women, respectively, in a contemporary primary care cohort in the community in Scotland.Methods and resultsData 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 modelling was undertaken using Cox proportional hazards models, adjusted for potential confounders. A total of 56 658 subjects were eligible for inclusion in the study. These represented a total of 147 938 person-years of follow-up (median follow-up: 2.04 years). In men, HF (reference group; 5-year survival: 55.8%) had worse mortality outcomes than prostate cancer [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.57–0.65; 5-year survival: 68.3%], and bladder cancer (HR 0.88, 95% CI 0.81–0.96; 5-year survival: 57.3%), but better outcomes than lung cancer (HR 3.86, 95% CI 3.65–4.07; 5-year survival: 8.4%) and colorectal cancer (HR 1.23, 95% CI 1.16–1.31; 5-year survival: 48.9%). In women, HF (reference group; 5-year survival: 49.5%) had worse mortality outcomes than breast cancer (HR 0.55, 95% CI 0.51–0.59; 5-year survival 77.7%), but better outcomes than colorectal cancer (HR 1.21, 95% CI 1.13–1.29; 5-year survival 51.5%), lung cancer (HR 3.82, 95% CI 3.60–4.05; 5-year survival 10.4%), and ovarian cancer (HR 1.98, 95% CI 1.80–2.17; 5-year survival 38.2%).ConclusionsDespite advances in management, HF remains as ‘malignant’ as some of the common cancers in both men and women.

AB - AimsThis study was designed to evaluate whether survival rates in patients with heart failure (HF) are better than those in patients with diagnoses of the four most common cancers in men and women, respectively, in a contemporary primary care cohort in the community in Scotland.Methods and resultsData 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 modelling was undertaken using Cox proportional hazards models, adjusted for potential confounders. A total of 56 658 subjects were eligible for inclusion in the study. These represented a total of 147 938 person-years of follow-up (median follow-up: 2.04 years). In men, HF (reference group; 5-year survival: 55.8%) had worse mortality outcomes than prostate cancer [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.57–0.65; 5-year survival: 68.3%], and bladder cancer (HR 0.88, 95% CI 0.81–0.96; 5-year survival: 57.3%), but better outcomes than lung cancer (HR 3.86, 95% CI 3.65–4.07; 5-year survival: 8.4%) and colorectal cancer (HR 1.23, 95% CI 1.16–1.31; 5-year survival: 48.9%). In women, HF (reference group; 5-year survival: 49.5%) had worse mortality outcomes than breast cancer (HR 0.55, 95% CI 0.51–0.59; 5-year survival 77.7%), but better outcomes than colorectal cancer (HR 1.21, 95% CI 1.13–1.29; 5-year survival 51.5%), lung cancer (HR 3.82, 95% CI 3.60–4.05; 5-year survival 10.4%), and ovarian cancer (HR 1.98, 95% CI 1.80–2.17; 5-year survival 38.2%).ConclusionsDespite advances in management, HF remains as ‘malignant’ as some of the common cancers in both men and women.

KW - heart failure

KW - cancer

KW - mortality

U2 - 10.1002/ejhf.822

DO - 10.1002/ejhf.822

M3 - Article

VL - 19

SP - 1095

EP - 1104

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

IS - 9

ER -