Impact of low serum albumin levels on cardiovascular deaths in cancer survivors with heart failure

Advancements in cancer treatment have iproved the long-term prognosis, leading to an increasing number of cancer survivors with coexisting heart failure (HF). Cardiovascular (CV) death is one of the major causes of death among cancer survivors with HF, highlighting the crucial need for risk stratification for CV death to improve their long-term prognosis. However, the specific risk factors for CV death in cancer survivors with HF are not fully understood. We enrolled 485 cancer survivors who were admitted to our hospital for treatment of HF between 2011 and 2023. All patients were prospectively followed up for a median period of 545 days with the endpoint of all-cause death. During the follow-up period, there were 107 CV deaths, which accounted for more than half of the total deaths and were four times higher than cancer deaths. Multivariate Fine-Gray analysis showed that low serum albumin levels independently predicted CV death after adjustment for confounding factors (sub-distribution hazard ratio [sHR], 0.740 per 1-SD increase; 95% confidence interval [CI], 0.580–0.946; P = 0.016). When using the albumin cut-off value of 3.7 g/dL for CV death, the patients with low albumin levels had significantly higher risk for CV death (sHR, 0.557; 95% CI, 0.376–0.825; P = 0.004). Low serum albumin levels were identified as an independent predictor of CV death in cancer survivors with HF. Serum albumin levels may be a useful biomarker for improving the prognosis of this high-risk population.