Cancer and the risk of death, heart-failure hospitalization, and major adverse cardiovascular events in HFpEF - a propensitymatched cohort study

Sep 22, 2026

Cancer and heart failure with preserved ejection fraction (HFpEF) frequently co-occur in older adults, but the independent impact of cancer on clinical outcomes in HFpEF is unclear. This single-center retrospective propensitymatched cohort study used electronic health records from January 2020 to December 2024, stratifying HFpEF patients by biopsy-proven or imaging-confirmed cancer history and evaluating mortality, HF hospitalization, and MACE, plus functional and health-status changes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Background

Methods

Study design and outcomes

Propensity-score matching and statistical analysis

Results

Matched cohort findings

Secondary outcomes and subgroup analyses

Conclusions

Keywords

TYPE Original Research PUBLISHED 13 February 2026 DOI 10.3389/fonc.2026.1728009 OPEN ACCESS EDITED BY Matthew Yousefzadeh, Columbia University, United States REVIEWED BY Matthew Yousefzadeh, Columbia University, United States Ibrahim Abdelgawad, AbbVie, United States *CORRESPONDENCE Jianhua Jiao [mnqw1230901@163.com](mnqw1230901@163.com) †These authors share ﬁrst authorship RECEIVED 19 October 2025 REVISED 27 November 2025 ACCEPTED 12 January 2026 PUBLISHED 13 February 2026 CITATION Li C, Meng F, Xie Y, Li P and Jiao J (2026) Cancer and the risk of death, heart-failure hospitalization, and major adverse cardiovascular events in HFpEF: a propensitymatched cohort study. Front. Oncol. 16:1728009 . doi: 10.3389/fonc.2026.1728009 COPYRIGHT © 2026 Li, Meng, Xie, Li and Jiao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Cancer and the risk of death, heart-failure hospitalization, and major adverse cardiovascular events in HFpEF: a propensitymatched cohort study Chunling Li 1†, Fanhua Meng 1†, Yunbo Xie 2, Peng Li 3 and Jianhua Jiao 1* 1Geriatric Department, Zhangjiakou First Hospital, Zhangjiakou, China, 2Cardiology Department, Zhangjiakou First Hospital, Zhangjiakou, China, 3 Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology, Beijing, China Background: Cancer and heart failure with preserved ejection fraction (HFpEF) frequently coexist in older adults and may share pathobiology, yet the independent effect of cancer on clinical outcomes in HFpEF remains uncertain. Methods: We performed a single-center, retrospective cohort study using electronic health records from January 2020 through December 2024 . Adults with HFpEF were stratiﬁed by a history of biopsy-proven or imaging-conﬁrmed cancer. Primary outcomes were all-cause mortality, heart-failure hospitalization (HFH), and a composite of major adverse cardiovascular events (MACE: nonfatal myocardial infarction, HF rehospitalization, or arrhythmia requiring intervention) . Secondary outcomes included change in New York Heart Association (NYHA) class, health status by Kansas City Cardiomyopathy Questionnaire (KCCQ), cause-speciﬁc mortality, and HFpEF-related health-care utilization. Propensityscore matching (PSM; 1:1 nearest-neighbor, caliper 0.2) balanced key covariates (age, sex, comorbidities, renal function, biomarkers, NYHA class, and LVEF) . Time-to-event analyses used Kaplan–Meier methods and Cox proportionalhazards models with Greenwood 95% conﬁdence bands and Schoenfeld diagnostics; prespeciﬁed subgroup analyses evaluated age, diabetes, chronic kidney disease (CKD), and NT-proBNP strata. Results: Of 403 eligible patients (cancer, 174; non-cancer, 229; median followup, 36 months), PSM yielded 306 patients (153 per group) with excellent covariate balance. In the matched cohort, cumulative incidences at 48 months were higher with cancer than without for all-cause mortality (31 .4% vs. 15. 0%; log-rank P = 0. 012), HFH (36 .7% vs. 22. 9%; P = 0 . 031), and MACE (43 . 1% vs. 32.7%; P = 0 . 050) . In multivariable Cox models for HFH, cancer remained independently associated with risk across progressive adjustments: age-adjusted hazard ratio (HR) 1.42 (95% CI, 1.08–1.87), age-and-sex adjusted HR 1.40 (1.06–1.85), and fully adjusted HR 1 .38 (1 .02–1. 87) after additional control for diabetes, CKD, and NT-proBNP. Subgroup analyses showed directionally consistent cancer effects without signiﬁcant interactions (all P for interaction ≥0

FAQs

What was the study purpose regarding cancer and HFpEF outcomes?

To determine whether cancer independently increases mortality, heart-failure hospitalization, and major adverse cardiovascular events (MACE) in patients with HFpEF.

How were cancer and HFpEF patients grouped for analysis?

Adults with HFpEF were stratified by a history of biopsy-proven or imaging-confirmed cancer, then compared using propensity-score matching (1:1 nearest-neighbor, caliper 0.2).

Which outcomes did the study evaluate, and what did it find in the matched cohort?

Primary outcomes were all-cause mortality, HF hospitalization (HFH), and MACE, with secondary outcomes including NYHA class change and health status. In the matched cohort, cumulative incidences at 48 months were higher for cancer versus non-cancer in all primary outcomes, and cancer remained independently associated with HFH in multivariable Cox models.

Sep 22, 2026

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