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

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. [ABSTRACT FROM AUTHOR]