Congress Review | Editors Choice | AHA Scientific Sessions 2024
Time to read: 02:38
Time to listen: 06:02
Published on MedED: 25 November 2024
Originally Published: 11 November 2024
Sourced: Circulatory
Type of article: Conference Review | In Brief
MedED Catalogue Reference: MCABC008
Category: Cardiovascular Disease
Cross Reference: Oncology, Women's Health
Keywords: cardiovascular disease, breast cancer, oxidative stress,
This study highlights the significant burden of cardiogenic shock in breast cancer patients, emphasising the need for early recognition, rapid intervention, and a multidisciplinary approach to improve outcomes, particularly in LMICs like South Africa.
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Presented at AHA Scientific Sessions 2024 and published as an Abstract in Circulatory 11 November 2023. This summary does not represent the original research, nor is it intended to replace the original research. Content Disclaimer
The prevalence of comorbid conditions in breast cancer patients is rising across sub-Saharan Africa (SSA) and other regions of the Global South, contributing to significant disparities in health outcomes between high-income and low- to middle-income countries (LICs/MICs).
In particular, breast cancer patients in Southern and Eastern Africa face a dual burden of non-communicable diseases (NCDs) like obesity and hypertension, compounded by HIV, which is associated with nearly a 50% increase in mortality.1
Cardiovascular diseases and cancer remain the leading causes of death worldwide, and recent evidence suggests that these conditions share common underlying factors, such as inflammation and oxidative stress. However, limited data exist on the intersection of cardiogenic shock and breast cancer, particularly in LICs/MICs, where early recognition and management are crucial to improving patient outcomes.
Study Intention
This study aimed to investigate the prevalence, complications, and clinical and economic outcomes of cardiogenic shock in patients with breast cancer, utilising a large, population-based dataset.
Participants
The study included 516,125 patients, of whom 11.3% experienced cardiogenic shock.
Patients with a primary diagnosis of breast cancer were identified using ICD-10 diagnostic codes.
Study Design
This retrospective cohort study analysed data from the National Inpatient Sample Database for the years 2018–2020.
The primary outcomes included mortality and key complications including arrhythmias, cardiac arrest, and acute kidney injury.
Secondary outcomes focused on systemic inflammatory response syndrome (SIRS) and healthcare costs.
Study Findings
The analysis revealed stark differences in clinical outcomes and costs between patients with and without cardiogenic shock:
Cardiogenic shock occurred in 11.3% of breast cancer patients during the study period.
Patients with cardiogenic shock had a mortality rate of 11.8%, significantly higher than the 4.1% observed in those without shock (OR 1.9, CI 1.5–2.4, p < 0.05).
Patients with cardiogenic shock were 20% more likely to develop arrhythmias (OR 1.2, CI 1.13–1.4, p < 0.05).
The risk of cardiac arrest was more than doubled (OR 2.1, CI 1.3–2.9, p < 0.05).
Patients had a twofold increased risk of Acute kidney injury (AKI): (OR 2.2, CI 2.1–2.3, p < 0.05).
A nearly threefold increase in SIRS incidence was noted (OR 2.8, CI 2.5–3, p < 0.05)
Patients with cardiogenic shock incurred significantly higher hospitalization costs ($77,185 vs. $64,300; p < 0.05), reflecting the complexity of care and management.
Study Implications
The rising prevalence of comorbid conditions in breast cancer patients across sub-Saharan Africa (SSA) and other regions of the Global South, particularly in low- to middle-income countries (LICs/MICs), is contributing to significant disparities in health outcomes compared to high-income countries.
The high mortality rate from cardiogenic shock in patients with breast cancers (11.8%) highlights the need for a multi-disciplinary approach to the care of these patients, including cooperation between oncologists, cardiologists and intensivists. Furthermore, heightened vigilance by these practitioners and the development of rapid intervention strategies would contribute significantly to improved outcomes for these patients.
Conclusion
This study underscores the substantial clinical and economic burden posed by cardiogenic shock in breast cancer patients, emphasising the importance of proactive strategies, including advanced monitoring and prompt intervention, to mitigate adverse outcomes.
Limitations
Unavailable for this review
Original Research Study
Bajwa, A. T., Iqbal, R., Jafar, A., Linn, H. N., Sanka, S., Gollamudi, S., Gaddam, M., & Mallick, A. (2024). Abstract 4138552: Prevalence, complications, and outcomes of cardiogenic shock in breast cancer patients: A population-based study. Circulation, 150(Suppl_1). https://doi.org/10.1161/circ.150.suppl_1.4138552
Funding
Unavailable for this review
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Additional References
1. Ayeni OA, Norris SA, Joffe M, Cubasch H, Galukande M, Zietsman A, Parham G, Adisa C, Anele A, Schüz J, Anderson BO, Foerster M, Dos Santos Silva I, McCormack VA. Preexisting morbidity profile of women newly diagnosed with breast cancer in sub-Saharan Africa: African Breast Cancer-Disparities in Outcomes study. Int J Cancer. 2021 May 1;148(9):2158-2170. doi: 10.1002/ijc.33387. Epub 2020 Nov 25. PMID: 33180326; PMCID: PMC8129872.
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