Trends in modes of death in heart failure over the last two decades: less sudden death but cancer deaths on the rise

Pedro Moliner, Josep Lupón, Marta de Antonio, Mar Domingo, Evelyn Santiago-Vacas, Elisabet Zamora, Germán Cediel, Javier Santesmases, Crisanto Díez-Quevedo, Maria Isabel Troya, Maria Boldó, Salvador Altmir, Nuria Alonso, Beatriz González, Julio Núñez, Antoni Bayes-Genis

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41 Citations (Scopus)


© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology Aims: Better management of heart failure (HF) over the past two decades has improved survival, mainly by reducing the incidence of death due to cardiovascular (CV) causes. Deaths due to non-CV causes, particularly cancer, may be increasing. This study explored the modes of death of consecutive patients who attended a HF clinic over 17 years. Methods and results: A total of 935 deaths were ascertained from 2002 to 2018 among 1876 patients (mean age 65.8 ± 12.5 years, 75% men, left ventricular ejection fraction < 50%) admitted to our HF clinic. Median follow-up was 4.2 years [1.9–7.8]. Mode of death was curated from patient health records and verified by the Catalan and Spanish health system databases. Trends for every mode of death were assessed by polynomial regression. Two trends were observed: a significant reduction in sudden death (P = 0.03) without changes in HF progression as mode of death (P = 0.26), and a significant increase in non-CV modes of death (P < 0.001). Non-CV deaths accounted for 17.4% of deaths in 2002 and 65.8% of deaths in 2018. A total 138 deaths were due to cancer (37% of non-CV deaths). A significant trend was observed towards a progressive increase in cancer deaths over time (P = 0.002). The main mode of cancer mortality was lung cancer. Conclusions: The modes of death in HF have shifted over the last two decades. Patients with HF die less due to sudden death and more due to non-CV causes, mainly cancer. Whether HF triggers cancer, or cancer develops in HF survivors, deserves further insight.
Original languageEnglish
JournalEuropean Journal of Heart Failure
Publication statusPublished - 1 Jan 2019


  • Cancer
  • Cardiovascular death
  • Heart failure
  • Mortality
  • Non-cardiovascular death
  • Sudden death


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