Investigators have highlighted a critical connection between heart failure and cancer, demonstrating how shared mechanisms may contribute to the incidence and progression of both diseases, according to a recent scientific statement published by Bloom et al in the Journal of Cardiac Failure.
Background
The concept of permissive cardiotoxicity highlights an emerging approach of maintaining life-saving cancer therapies while accepting some degree of cardiotoxicity and mitigating risk through cardioprotective strategies.
“We are only scratching the surface in the expanding field of cancer therapeutics. As we advance, it becomes clear that understanding the full spectrum of cardiac toxicities, including heart failure, is essential for maximizing treatment benefits and safeguarding patient heart health,” explained co–lead study author Michelle Bloom, MD, Professor in the Department of Medicine at the New York University (NYU) Grossman School of Medicine and Director of the Cardio-Oncology Program at NYU Langone Heart.
Findings From the Scientific Statement
In the scientific statement, a team of investigators—comprising heart failure specialists, cardio-oncologists, oncologists, and pharmacists—developed a document with the goal of establishing more uniform recommendations such as standardized cardiac imaging protocols during cancer therapies to prevent heart-related complications. They noted that further protocols may be needed regarding permissive cardiotoxicity, which acknowledges the need to balance increased heart failure risk to ensure optimal cancer treatment. Careful evaluations by heart failure specialists could be crucial in cancer treatments, particularly during risk assessment for heart transplantation and durable left ventricular assist device placement.
The investigators showed that patients with cancer may be at an increased risk of developing heart failure, whereas patients with heart failure may face a heightened risk of cancer. For instance, heart failure and cancer were found to share common pathophysiologic mechanisms that influence disease incidence and progression, representing a reciprocal relationship.
Beyond anthracyclines and HER2-targeted monoclonal antibodies, there are currently few cancer therapeutics that have standardized cardiac imaging surveillance recommendations, resulting in significant variations in clinical practice.
The investigators indicated that heart failure with preserved ejection fraction is an important yet underrecognized aspect of cancer therapy–related cardiotoxicity, described in a wide array of cancer therapeutics—including Bruton’s tyrosine kinase inhibitors, chimeric antigen receptor T-cell therapies, and hematopoietic stem cell transplantation.
Cardiogenic shock in patients with cancer may arise from various causes, including left ventricular dysfunction caused by cancer therapies, acute coronary syndrome, stress-induced cardiomyopathy, and immune checkpoint inhibitor–associated myocarditis. Durable left ventricular assist devices are feasible in patients with stage D heart failure related to chemotherapy-induced cardiomyopathy, with similar survival rates compared with other causes of cardiomyopathy. Immune checkpoint inhibitor–associated myocarditis should be recognized and treated urgently as a result of its severe nature and high risk of mortality. Multidisciplinary care may be critical for accurate diagnosis and effective management, especially in patients who are hemodynamically unstable.
Among candidates with a history of cancer, careful and individualized risk assessment in collaboration with oncology specialists may be crucial to determine eligibility for heart transplantation. This includes evaluating the impact of preexisting neoplasms and the risk of cancer recurrence, with a personalized approach essential to prevent unnecessary delays in transplant listing.
Palliative care involvement may be essential for enhancing the quality of life of patients with both cancer and heart failure, and it should be integrated early to manage symptoms, psychological stress, and care coordination. There is a growing push to integrate palliative care practices from oncology and cardiology to improve care for these patients, supported by clinical research and professional recommendations.
Racial and ethnic minorities and LGBTQ+ patients may experience significant health disparities in cancer and cardiovascular care because of systemic issues such as delayed screenings and limited access to quality care. Strategies to address these inequities include community outreach, inclusive research, and improved access to care and clinical trials.
Conclusions
The findings emphasized the need for coordinated care between cardiology and oncology.
“This statement highlights the need for a multidisciplinary approach to managing heart failure in [patients with] cancer, emphasizing that understanding the intersection of these two complex conditions is vital for enhancing patient outcomes and addressing disparities in care,” Dr. Bloom underscored. “We hope that this document becomes the go-to resource for anything and everything cardio-oncology in heart failure practices,” she concluded.
Disclosure: For full disclosures of the scientific statement authors, visit onlinejcf.com.
