Cardiology care, cardiovascular comorbidities and all-cause mortality in long-term breast cancer survivors: a retrospective cohort study.

INTRODUCTION AND

OBJECTIVES

Breast cancer survivors (BCS) have an elevated risk of cardiovascular disease (CVD), but standardized follow-up protocols remain limited. We aimed to describe cardiovascular comorbidities and the utilization of specialized health services, particularly cardiology services, among BCS, and to examine their association with mortality.

METHODS

We conducted a retrospective cohort study of 6186 BCS diagnosed between 2000 and 2006 who survived at least 5 years after diagnosis. Participants were followed up from 2012 to 2016. Health care use and comorbidities obtained from electronic health records were analyzed. A multivariate time-dependent Cox proportional hazards model was used to assess the association between use of cardiology services and all-cause mortality.

RESULTS

A total of 43.6% of long-term BCS had CVD at the beginning of follow-up. Women with CVD were older (mean age 71.8 vs 62 years; P<.001) and had a substantially higher comorbidity burden than those without CVD (5.83 vs 1.96; P <.001). During follow-up, 781 BCS (12.6%) died. Nonsurvivors were older and had a greater and more severe baseline comorbidity burden than survivors. They also had higher rates of specialist visits. Use of cardiology services was associated with lower mortality, although the association did not reach statistical significance (HR, 0.84; 95%CI, 0.67-1.05; P=.12).

CONCLUSIONS

The prevalence of CVD among BCS was high, although only 18.8% used cardiology services. Nonsurvivors had a higher CVD burden and severity, and showed greater use of health care services.