Abstract 4358285: In-Hospital Outcomes of Acute Heart Failure Subtypes in Patients with Breast Cancer: A Nationwide Analysis

Background: Breast cancer (BC) is the most common cause of cancer-related mortality among women. Despite advancements in treatment and longer survival, BC patients are at a higher risk of heart failure (HF) with an increased relative risk of 20% as compared to the general population. This has been attributed to cardiotoxicity from BC treatment and shared pathophysiological mechanisms. However, there is a need for more data on the outcomes of BC patients admitted with acute heart failure (AHF). Aim: To evaluate clinical outcomes, including in-hospital mortality, cardiogenic shock, respiratory failure, and length of stay (LOS), across different subtypes of AHF in BC patients. Methods: We analyzed the National Inpatient Sample database (2019-2022) to identify BC patients admitted with a primary diagnosis of AHF. AHF subtypes were classified into acute systolic heart failure (ASHF), acute diastolic heart failure (ADHF), combined ASHF/ADHF, and acute right heart failure (ARHF) based on ICD codes. Demographic information and clinical outcomes were collected and compared across AHF subtypes. Results: We identified 50,623 hospitalizations for AHF in patients with BC. The majority had ADHF only (55.6%), followed by ASHF (27.8%), combined ASHF/ADHF (16.1%), and ARHF (0.6%). The mean age across all groups was 77.8 years (SD ±10.2). In terms of racial distribution, most patients were White (73.6%), followed by Black (15.3%) and Hispanic (5.1%). The overall in-hospital mortality rate was 4.4%, with ARHF had the highest mortality at 12.2%, followed by ASHF (4.9%), combined ASHF/ADHF (4.5%), and ADHF (4.1%). Cardiogenic shock occurred in 2.6% of all AHF cases, most frequently in ARHF (8.2%) and ASHF (5.0%), and least in ADHF (1.0%). Respiratory failure was seen in 46.2% of all AHF patients—highest in ARHF (59.9%) and ADHF (50.3%). Mean LOS for AHF admissions was 6.11 days, ranging from 6.0 days in ASHF to 6.59 days in ARHF. Conclusion: Patients with ARHF had the highest rates of mortality, cardiogenic shock, respiratory failure, and the longest hospital stays, likely indicating a more severe clinical course. ADHF was the most common subtype but was associated with the lowest mortality and complication rates. These findings highlight the importance of recognizing AHF subtype in this population, as it may have significant implications for prognosis, management strategies, and healthcare resource allocation.