Background: Cancer and heart failure (HF) frequently coexist due to population ageing and improved survival for both conditions. HF is a well-recognised complication of oncologic therapies and a potential association between HF and subsequent cancer incidence has been recently noticed. We therefore conducted a meta-analysis to quantify cancer incidence and mortality in patients with and without HF. Methods: Databases were searched from inception to 15 February 2026. Data from observational studies and randomised trials on individuals with and without HF and reporting cancer incidence and/or mortality during follow-up were included. The main outcome of interest was the incidence of any cancer; secondary outcomes included site-specific cancer incidence (lung, colorectal, breast, and prostate) and all-cause, cardiovascular, and cancer-related mortality. Results: Twelve studies comprising 8,979,195 individuals were included. HF was associated with a higher incidence of cancer (hazard ratio [HR] 1.33, 95% confidence interval [CI] 1.14-1.54), with substantial heterogeneity (I2 = 99.7%). Cancer site-specific analyses showed increased incidences of lung (HR 1.70, 95% CI 1.26-2.29), colorectal (HR 1.28, 95% CI 1.11-1.48), and breast (HR 1.19, 95% CI 1.04-1.37), but not prostate, cancer. Effect estimates varied according to analytical strategy: matched HF and non-HF cohorts reported higher risk estimates than those using covariate adjustment without matching. Mortality data were sparse and heterogeneous. Conclusions: HF is associated with a higher incidence of cancer, although with marked heterogeneity among studies and cancer types. Mortality and cause of death were rarely reported. The observed HF-cancer association is influenced by statistical methodology, shared risk factors, differences in surveillance intensity and cancer type, that confound analyses investigating possible causal biological links. More granular and harmonised studies are required.
Sanasi, L., Iaconelli, A., Azzolina, D., Dolce, P., Cardile, C., Cacioli, L., Forni, A., Busti, M., Sensini, L., Pugliese, N. R., D'Amario, D., Pecorini, G., Galli, M., Liuzzo, G., Burzotta, F., Rinaldi, R., Morsy, M. I., Maffia, P., Pellicori, P., Friday, J. M., Petrie, M., Haring, B., Böhm, M., Anker, M. S., Butler, J., Crea, F., Cleland, J. G. F., Heart Failure and Cancer: Incidence and Mortality Patterns, A Systematic Review and Meta-analysis, <<EUROPEAN JOURNAL OF HEART FAILURE>>, 2026; (Aug 25): N/A-N/A. [doi:10.1093/ejhf/xuag265] [https://hdl.handle.net/10807/345758]
Heart Failure and Cancer: Incidence and Mortality Patterns, A Systematic Review and Meta-analysis
Sanasi, Luigi;Iaconelli, Antonio;Cardile, Christian;Cacioli, Lorenzo;Forni, Alessandro;Busti, Matteo;Sensini, Luca;D'Amario, Domenico;Pecorini, Giovanni;Liuzzo, Giovanna;Burzotta, Francesco;Rinaldi, Riccardo;Crea, Filippo;
2026
Abstract
Background: Cancer and heart failure (HF) frequently coexist due to population ageing and improved survival for both conditions. HF is a well-recognised complication of oncologic therapies and a potential association between HF and subsequent cancer incidence has been recently noticed. We therefore conducted a meta-analysis to quantify cancer incidence and mortality in patients with and without HF. Methods: Databases were searched from inception to 15 February 2026. Data from observational studies and randomised trials on individuals with and without HF and reporting cancer incidence and/or mortality during follow-up were included. The main outcome of interest was the incidence of any cancer; secondary outcomes included site-specific cancer incidence (lung, colorectal, breast, and prostate) and all-cause, cardiovascular, and cancer-related mortality. Results: Twelve studies comprising 8,979,195 individuals were included. HF was associated with a higher incidence of cancer (hazard ratio [HR] 1.33, 95% confidence interval [CI] 1.14-1.54), with substantial heterogeneity (I2 = 99.7%). Cancer site-specific analyses showed increased incidences of lung (HR 1.70, 95% CI 1.26-2.29), colorectal (HR 1.28, 95% CI 1.11-1.48), and breast (HR 1.19, 95% CI 1.04-1.37), but not prostate, cancer. Effect estimates varied according to analytical strategy: matched HF and non-HF cohorts reported higher risk estimates than those using covariate adjustment without matching. Mortality data were sparse and heterogeneous. Conclusions: HF is associated with a higher incidence of cancer, although with marked heterogeneity among studies and cancer types. Mortality and cause of death were rarely reported. The observed HF-cancer association is influenced by statistical methodology, shared risk factors, differences in surveillance intensity and cancer type, that confound analyses investigating possible causal biological links. More granular and harmonised studies are required.
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