In a study reported in JAMA Oncology, Barac et al developed a risk prediction model for heart failure or cardiomyopathy (HF/CM) after breast cancer treatment.
Study Details
The aim of the study was to construct a model predicting the 10-year risk of developing HF/CM in women receiving systemic treatment for invasive early-stage breast cancer. The study involved data from 26,044 patients in the Kaiser Permanente Southern California health-care system with newly diagnosed invasive local or regional disease from 2008 to 2020. The cohort was randomly divided into derivation (60%) and validation (40%) cohorts. HF/CM risk predictors used in developing the model risk score included age at breast cancer diagnosis; race and ethnicity; area-level socioeconomic status; local and systemic breast cancer treatments; cancer stage; obesity; and history of hypertension, diabetes, hyperlipidemia, smoking, and other cardiovascular conditions. Median age was 61 years (interquartile range = 52–68 years).
Key Findings
Women were categorized into low-, moderate-, and high-risk cohorts based on tertiles of risk scores in the derivation cohort.
Risks of HF/CM at 10 years in the validation cohort (which matched those in the derivation cohort) were: 1.7% (95% confidence interval [CI] = 1.1%–2.4%) in the low-risk cohort, 6.3% (95% CI = 5.1%–7.5%) in the moderate-risk cohort, and 19.4% (95% CI = 17.3%–21.5%) in the high-risk cohort. Respective risks at 5 years were 1.1% (95% CI = 0.7%–1.4%), 3.4% (95% CI = 2.7%–4.0%), and 9.5% (95% CI = 8.3%–10.6%).
Good discriminative ability of the model to predict HF/CM was exhibited, with time-dependent receiver operating characteristic area under the curve values at 1, 5, and 10 years of 0.74, 0.75, and 0.78 in the derivation cohort and 0.73, 0.76, and 0.79 in the validation cohort.
The investigators concluded: “This risk prediction model among women with early-stage [breast cancer] was able to prospectively identify those at risk of HF/CM over a 10-year period based on the selected [breast cancer] treatment and clinical variables available at [breast cancer] diagnosis. The model can be used to inform risk-guided cardiac management for these women.”
Arnold L. Potosky, PhD, of the Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the National Institutes of Health/National Heart, Lung, and Blood Institute. For full disclosures of all study authors, visit jamanetwork.com.
