S448 The Impact of Heart Failure on Colorectal Cancer Survival: A Propensity-Matched Cohort and Survival Analysis

Introduction: Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide and accounts for a significant proportion of global cancer mortality. While advances in diagnosis and treatment have improved survival rates, CRC survivors face a substantial risk of non-cancer mortality, with cardiovascular disease (CVD) being a leading cause. Despite this, postoperative surveillance in CRC patients remains predominantly focused on cancer recurrence, often overlooking the significant burden of CVD. Emerging evidence suggests a complex interplay between CRC and CVD, driven by shared risk factors, chronic inflammation, and systemic treatment-related cardiotoxicity. Methods: A retrospective cohort analysis was conducted using data from the TriNetX federated network, comparing 2 groups: Cohort 1 included 360,005 adult patients (≥18 years) diagnosed with CRC (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM]: C18) without a diagnosis of heart failure (ICD-10CM: I50), while Cohort 2 consisted of 59,961 patients with both CRC and HF diagnosis. Propensity score matching was performed on 24 characteristics, including demographic variables (e.g., age, sex, race/ethnicity), oncology stage, and comorbid conditions (e.g., ischemic heart disease, diabetes mellitus, hypertensive diseases, chronic kidney disease). Cardiovascular outcomes between the cohorts were compared using risk measures and Kaplan-Meier survival analysis. Statistical significance was evaluated using the log-rank test and hazard ratios, and proportionality assumptions were tested. Results: Each cohort consisted of 45,731 matched patients. Among patients with CRC; HF cohort had significantly lower survival probabilities and higher mortality risk compared to cohort without HF. The outcome (death) in the control group was 30.3% and in the HF cohort group was 42.1%. We found that the odds ratio for mortality was 1.389 (P-value < 0.001) (confidence interval [CI] of 1.36-1.41). The hazard ratio (HR) for survival was 0.653 (95% CI: 0.639–0.667), indicating that the risk of death was substantially higher in CRC patients with HF. Median survival was reduced by over 1,200 days in the HF cohort. Conclusion: Current CRC surveillance predominantly focuses on cancer recurrence, often overlooking the risks posed by comorbid conditions like HF. The data presented compellingly advocate for a paradigm shift towards integrated care pathways that concurrently address the dual burden of cancer and cardiovascular disease, ultimately optimizing outcomes for CRC patients.