Background:The prognosis of heart failure (HF) after early stage breast cancer (EBC) treatment with anthracyclines or trastuzumab is not well-characterized.Methods:Using administrative databases, women diagnosed with HF after receiving anthracyclines or trastuzumab for EBC in Ontario during 2007 to 2017 (the EBC-HF cohort) were categorized by cardiotoxic exposure (anthracycline alone, trastuzumab alone, sequential therapy with both agents) and matched on age with ≤3 cancer-free HF controls to compare baseline characteristics. To study prognosis after HF onset, we conducted a second match on age plus important HF prognostic factors. The cumulative incidence function was used to describe risk of hospitalization or emergency department visits (hospital presentations) for HF and cardiovascular death.Results:A total of 804 women with EBC developed HF after anthracyclines (n=312), trastuzumab (n=112), or sequential therapy (n=380); they had significantly fewer comorbidities than 2411 age-matched HF controls. After the second match, the anthracycline-HF cohort had a similar 5-year incidence of HF hospital presentations (16.5% [95% CI, 12.0%–21.7%]) as controls (17.1% [95% CI, 14.4%–20.1%]); the 5-year incidence was lower than matched controls for the trastuzumab-HF (9.7% [95% CI, 4.7%–16.9%]; controls 16.4% [95% CI, 12.1%–21.3%]; P=0.03) and sequential-HF cohorts (2.7% [95% CI, 1.4%–4.8%]; controls 10.8% [95% CI, 8.9%–13.0%]; P<0.001). At 5 years, the incidence of cardiovascular death was 2.9% (95% CI, 1.2%–5.9%) in the anthracycline-HF cohort vs. 9.5% (95% CI, 6.9%–12.6%) in controls, and 1.7% (0.6%–3.7%) for women developing HF after trastuzumab vs. 4.3% (95% CI, 3.1–5.8%) for controls.Conclusions:Women developing HF after cardiotoxic EBC chemotherapy have fewer comorbidities than cancer-free women with HF; trastuzumab-treated women who develop HF have better prognosis than matched HF controls.

中文翻译：

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早期乳腺癌化疗后出现心力衰竭的女性的特征和结果：一项基于人群的匹配队列研究


背景：早期乳腺癌 (EBC) 使用蒽环类药物或曲妥珠单抗治疗后心力衰竭 (HF) 的预后尚不明确。方法：使用管理数据库，2007 年安大略省接受蒽环类药物或曲妥珠单抗治疗 EBC 后诊断为 HF 的女性至 2017 年（EBC-HF 队列）按心脏毒性暴露（单独使用蒽环类药物、单独使用曲妥珠单抗、两种药物序贯治疗）进行分类，并与≤3 个无癌 HF 对照进行年龄匹配，以比较基线特征。为了研究心力衰竭发作后的预后，我们对年龄和重要的心力衰竭预后因素进行了第二次匹配。累积发生率函数用于描述因心力衰竭和心血管死亡而住院或急诊就诊（医院就诊）的风险。 结果：共有 804 名患有 EBC 的女性在接受蒽环类药物（n=312）、曲妥珠单抗（n=112）后出现心力衰竭，或序贯疗法（n=380）；他们的合并症明显少于 2411 名年龄匹配的心力衰竭对照者。第二场比赛后，蒽环类心力衰竭队列的 5 年心力衰竭住院发生率 (16.5% [95% CI, 12.0%–21.7%]) 与对照组相似 (17.1% [95% CI, 14.4%–20.1]) %]);曲妥珠单抗-HF 的 5 年发生率低于匹配对照（9.7% [95% CI, 4.7%–16.9%]；对照 16.4% [95% CI, 12.1%–21.3%]； P =0.03）序贯心衰队列（2.7% [95% CI, 1.4%–4.8%]；对照组 10.8% [95% CI, 8.9%–13.0%]； P <0.001）。 5 年时，蒽环类药物-HF 队列中心血管死亡的发生率为 2.9%（95% CI，1.2%–5.9%），而对照组为 9.5%（95% CI，6.9%–12.6%），对照组为 1.7%。接受曲妥珠单抗治疗后发生心力衰竭的女性为 0.6%–3.7%，而对照组为 4.3%（95% CI，3.1–5.8%）。结论：心脏毒性 EBC 化疗后发生心力衰竭的女性比患有心力衰竭的无癌女性有更少的合并症；接受曲妥珠单抗治疗的发生心力衰竭的女性比匹配的心力衰竭对照患者预后更好。