ESC Congress 2026 Abstract · Oct 26, 2026

Persistence of guideline-directed medical therapy after heart failure hospitalisation in older adults with cancer

By Daigo K, Nishimura S, Kumamaru H et al.

Background: Heart failure (HF) and cancer frequently coexist in older adults. Although guideline-directed medical therapy (GDMT) is the foundation of contemporary HF management, its real-world implementation and persistence in patients with cancer remain poorly characterized. This gap is clinically relevant because interruption or withdrawal of HF therapy has been associated with clinical deterioration, while patients with cancer often face competing risks that may constrain GDMT optimization. We therefore aimed to delineate patterns of GDMT use and prognosis in older HF patients stratified by cancer status. Methods: Using a nationwide Japanese administrative database (DeSC, 2015–2022), we identified patients aged ≥65 years hospitalized for HF who initiated ≥1 GDMT class at discharge (i.e. angiotensin-converting enzyme inhibitors [ACEi]/angiotensin II receptor blockers [ARB]/angiotensin receptor-neprilysin inhibitors [ARNI], beta-blockers, mineralocorticoid receptor antagonists [MRA], or sodium-glucose co-transporter-2 inhibitors [SGLT2i]). Patients were categorized according to the presence of pre-existing cancer at baseline, defined by malignancy codes from the diagnostic codes in the claims, within 365 days before the index discharge. Drug-specific discontinuation was defined as a ≥60-day prescription gap within 1 year after discharge. We estimated cumulative incidence functions for discontinuation, treating death as a competing event. Subdistribution hazard ratios (sHRs) were estimated using Fine–Gray models adjusted for baseline characteristics. Adjusted hazard ratios (HRs) for one-year all-cause mortality were estimated using Cox models in the overall study population. Results: Among 33,463 hospitalized HF patients who initiated ≥1 GDMT class, 6,181 (18%) had pre-existing cancer. The mean age was 83 years in both groups. Receipt of beta-blockers (52.7% vs. 57.1%) and ACEi/ARB/ARNIs (41.0% vs. 49.2%) was less frequent in those with cancer than in those without, whereas MRA and SGLT2i use was similar between the two groups. After discharge, the cumulative incidence of discontinuation was comparable for ACEi/ARB/ARNIs and SGLT2is between patients with and without cancer, whereas discontinuation of beta-blockers (25.4% vs. 27.3%) and MRAs (39.8% vs. 43.5%) was lower in patients with cancer, with adjusted sHRs of 0.87 (95% CI 0.80–0.94) for beta-blockers and 0.86 (95% CI 0.80–0.92) for MRAs. The presence of cancer was associated with a higher risk of one-year mortality (HR 1.44, 95% CI 1.36–1.52). Conclusions: Once initiated, post-discharge GDMT persistence was broadly similar between patients with and without cancer, with modest class-specific differences; nevertheless, mortality remained substantially higher in the cancer cohort. These findings suggest that cancer should not be viewed as a reason to withhold or limit GDMT, yet improving outcomes will require strategies beyond HF pharmacotherapy.

doi.org/10.1093/eurheartj/ehag785.3844Open accessPopulations