Trastuzumab combined with anthracyclines increased the risk of developing CHF by 23% (HR 1.23, 95% CI 1.13-1.34, p<0.001) compared to no treatment among early-stage breast cancer patients.
Observational (n=206,605)
Yes
Do socioeconomic disparities and race/ethnicity influence the long-term risk of developing congestive heart failure in patients with early-stage breast cancer treated with or without trastuzumab and anthracyclines?
Socioeconomic factors, including Black race and lower per capita income, are independently associated with an increased long-term risk of developing heart failure in early-stage breast cancer survivors, even after adjusting for baseline cardiac comorbidities and cardiotoxic cancer therapies.
Effect estimate: HR 1.23 for T and A; HR 1.20 for A without T; HR 1.15 for T without A (each vs neither) (95% CI 1.13-1.34, 1.16-1.24, 1.09-1.21 respectively)
p-value: p=<0.001 for all
While it is well-established that cardiovascular disease and congestive heart failure (CHF) are increased among breast cancer survivors, little is known about how systemic therapy use, medical comorbidities, and socioeconomic factors interact to influence long-term cardiac outcomes. In this study, we performed an analysis of the SEER-Medicare database, including more than 200,000 patients with early-stage breast cancer. Using available zip code and census data, patient disease characteristics and cardiac outcomes were stratified by socioeconomic variables. Overall, patients of Black, Hispanic, and American Indian/Alaskan Native race/ethnicity had an increased incidence of large, high-grade tumors and nodal involvement as compared to White and Asian American/Pacific Islander (AAPI) patients. Lower per capita income (PCI), higher percentage of population living in poverty, lower level of education, and not speaking English at home were also associated with increased tumor size, grade, and nodal stage. Adjusting for cardiac covariates and cancer therapy type, a multivariate socioeconomic model revealed that Black patients had a higher risk of CHF and AAPI patients had a lower risk compared to White patients. Further adjusting for race/ethnicity, patients living in a zip code in the lowest quartile of PCI also had a higher risk of CHF compared to those in the highest quartile.
Britten et al. (2026) conducted an observational in Early-stage breast cancer (n=206,605). Trastuzumab with or without anthracyclines vs. No trastuzumab or anthracyclines was evaluated on Development of congestive heart failure (CHF) after breast cancer diagnosis defined by ICD9/ICD10 billing codes (HR 1.23 for T and A; HR 1.20 for A without T; HR 1.15 for T without A (each vs neither), 95% CI 1.13-1.34, 1.16-1.24, 1.09-1.21 respectively, p=<0.001 for all). Trastuzumab combined with anthracyclines increased the risk of developing CHF by 23% (HR 1.23, 95% CI 1.13-1.34, p<0.001) compared to no treatment among early-stage breast cancer patients.