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How does medication use change for patients taking treatment for heart failure when they have a cancer diagnosis?

Chengsheng Ju, University College London

 

Background

Heart failure (HF) and cancer are both common conditions that affect patients in the UK. These conditions can sometimes occur together in a patient. Patients living with both HF and cancer will inevitably have worse outcomes.

For patients with HF, it is important to maintain medical treatment at the target dose in order to make the treatment effective. When a patient already has heart failure, they are treated with a number of medicines. If they then have a cancer diagnosis they may be less likely to take these medicines or their cancer doctors may temporarily stop these, as patients may develop complications, such as vomiting, diarrhoea or unable to eat or drink due to cancer progression or cancer treatment. We think that there is a change in pattern in prescribing of medicines for heart failure but this has never been shown; additionally we do not know what the impact of this is on the future management of a patients’ heart condition. Also, we believe that the medicines taken for heart failure are not monitored well enough in those having treatment for cancer.

Aims and objectives

We want to 1) compare the use of HF medicines before and after a patients’ diagnosis with cancer; 2) How can patient factors predict the change in use of HF medicines; and 3) compare patients that have had changes in terms of hospitalisation and death.

Methods

There are two databases we can use to enable us to meet our aims. The IMRD-UK primary care database in the UK and the CDARS hospital database in Hong Kong. These data has the prescribing information and diagnosis information. There will be two analyses. In the first analysis, we will focus on finding out the pattern of cardiovascular medication utilisation in the patients before and after a cancer diagnosis. We are interested in the change in the number of patients on medical treatment and doses they received. We will be using statistical methods to find the patient factors that can predict the interruption of cardiovascular medications. In the second analysis, we will focus on finding out how the interruption of cardiovascular treatment may lead to worse patient outcomes. We will compare the risk of death and HF-related hospitalisation between patients maintained the optimal medical therapy versus those who experienced treatment interruption after cancer diagnosis. Patient factors that may confound the results will be adjusted accordingly using statistical methods.

How the results of the research will be used

This study is very important to the cancer community as the number of patients are increasing with cancer. We will therefore not only publish our findings but will present them at various UK based and international meetings. In the UK, cancer pharmacists have a role in the management of patients medicines that are non- cancer related. This information may be used to help them optimize both cancer and non-cancer treatments.