The impact of iron deficiency anemia on long-term cardiovascular outcomes in breast cancer patients hospitalized with heart failure preserved ejection fraction: A propensity score–matched retrospective cohort study.

Abstract

11041 Background: Breast cancer (BC) patients are at risk for iron deficiency anemia (IDA) due to the effects of chemotherapy on the bone marrow and because of potential malignant infiltration of the bone marrow. Additionally, BC patients are at increased risk for heart failure either from the effects of chemoradiation on the myocardium or because of direct tumor invasion of the heart. Studies have shown that IDA is associated with worse functional outcomes, hospitalization, and mortality in heart failure preserved ejection fraction (HFpEF). There is limited data on the impact of IDA on long-term cardiovascular outcomes in BC patients with HFpEF, and our study aims to assess these outcomes. Methods: We utilized data from the Global Collaborative Network-TriNetX. Patients aged 18 to 85 were divided into two cohorts: those with BC, HFpEF, and IDA, and those with BC, HFpEF but without IDA. Using ICD-10 codes, we evaluated the following outcomes: risk of myocardial infarction (MI), arrhythmia, cardiogenic shock, mortality, and hospitalization. Generalized linear models were used to measure the association, and estimates were presented as risk ratios and 95% confidence intervals. Results: After propensity score matching, each cohort consisted of 9,204 patients. The IDA cohort had a mean age of 74.4 ± 8.6 years and 94% were female. Caucasians accounted for 65% of patients and blacks 21%. Our study found that over a 5-year period (Table 1), BC patients with HFpEF and concomitant IDA had a statistically significant higher risk of MI (RR: 1.576, 95% CI 1.408-1.765), arrhythmia (RR: 1.589, 95% CI 1.300-1.942), cardiogenic shock (RR: 1.660, 95% CI 1.347-2.045), and mortality (RR: 1.052, 95% CI 1.002-1.104). There was an increased risk of hospitalization (RR: 1.256, 95% CI 0.871-1.813) but the results were statistically insignificant. Conclusions: Our study demonstrated that IDA is associated with long-term adverse cardiovascular outcomes in BC patients with HFpEF. More prospective studies are needed to assess the impact of iron therapy on cardiovascular outcomes, specifically in the BC population with HFpEF. Long term cardiovascular outcomes in breast cancer patients with heart failure preserved ejection fraction. 1 year follow up 5 year follow up Outcome RR and 95% CI p value RR and 95% CI p value Myocardial Infarction 1.481 (1.261-1.738) <0.001 1.576 (1.408-1.765) <0.001 Arrhythmia 1.631 (1.206-2.207) 0.001 1.589 (1.300-1.942) <0.001 Cardiogenic Shock 1.592 (1.194-2.123) 0.001 1.660 (1.347-2.045) <0.001 Mortality 0.899 (0.840-0.963) <0.002 1.052 (1.002-1.104) 0.04 Hospitalization 1.335 (0.684-2.606) 0.40 1.256 (0.871-1.813) 0.2 RR: risk ratio, CI: confidence interval.