Comparison of cardiovascular disease risk assessment tools for heart failure prediction among cancer patients

Abstract Background Cancer survivors are at an increased risk of incident heart failure (HF) due to shared risk factors and cancer treatment-related cardiac dysfunction. Clinical assessment of HF risk would be an important first step towards HF prevention in survivors. This study compared HF risk calculators in survivors. Methods In this study from the UK Biobank, cancer and HF diagnoses were determined based on the International Classification of Diseases (ICD)-10 code and non-cancer participants were excluded. Participants risk of HF incidence was determined using the ESC Cardio-Oncology Risk Assessment (CORA), the Atherosclerosis Risk in Communities (ARIC-HF), Pooled Cohort Equations to Prevent Heart Failure (PCP-HF) and a general cardiovascular risk score (the Systematic Coronary Risk Evaluation [SCORE2]). The predictive performances of each were compared using the area under the curve (AUC). Results Of 43,720 survivors, 9,232 had breast cancer or lymphoma (mean age 60 years, 88% female), and 34,488 had other cancer types (mean age 60 years, 59% female). The discriminative value for CORA (AUC 0.757 [95%CI: 0.747-0.768]) and ARIC-HF (0.748 [95%CI: 0.737-0.758]) were similar, and superior to PCP-HF (0.701 [95%CI: 0.689-0.714]) and SCORE2 (0.685 [95%CI: 0.673-0.697]). The overall performance for each risk score was better among participants in other cancer types than those with breast cancer and lymphoma. Conclusions CORA and ARIC-HF outperformed the other scores, although all showed suboptimal discrimination for incident HF. A cancer-specific HF prediction tool could facilitate HF prevention among survivors.