Main Session
Sep
29
PQA 07 - Head and Neck Cancer, Lung Cancer/Thoracic Malignancies, and Nursing and Supportive Care
3608 - Association of Prior Thoracic Radiation with Clinical Outcomes in Patients Hospitalized for Heart Failure
Presenter(s)
Aren Saini, BS - University of Miami Miller School of Medicine, Miami, FL
A. S. Saini1, S. Ghay2, R. M. Narasimhan1, J. F. Eduardo Jr.1, B. Kaur2, S. G. Chithriki1, P. Ghay1, K. Samimi1, R. P. Singh3, A. Vera4, and D. Isrow4; 1University of Miami Miller School of Medicine, Miami, FL, 2Mount Sinai Medical Center, Miami Beach, FL, 3Edward Via College of Osteopathic Medicine - Louisiana Campus, Monroe, LA, 4Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
Purpose/Objective(s):
Thoracic radiation therapy (TRT) is widely used for intrathoracic malignancies and is associated with delayed cardiovascular toxicity, including cardiomyopathy and valvular disease. However, the impact of prior TRT on outcomes among patients hospitalized with heart failure (HF) remains incompletely characterized. As the population of cancer survivors grows, understanding inpatient outcomes in radiation-exposed patients is increasingly important. We therefore examined whether prior TRT influences clinical outcomes and resource utilization among HF hospitalizations.Materials/Methods:
A retrospective cohort study was conducted using the National Inpatient Sample (2016–2022). Adult hospitalizations with a primary diagnosis of HF were identified using ICD-10 codes. Prior thoracic radiation exposure was defined using diagnosis and treatment codes for intrathoracic malignancy and radiation. Survey-weighted analyses were performed to generate national estimates. To account for baseline differences between groups, a 1:1 nearest-neighbor propensity score–matched analysis was performed using prespecified covariates. Outcomes were compared between matched cohorts using appropriate weighted statistical tests. The primary endpoint was in-hospital mortality. Secondary endpoints included major inpatient complications, palliative care utilization, do-not-resuscitate (DNR) status, length of stay (LOS), and total hospital charges. A secondary analysis compared radiation-only versus chemotherapy-only cohorts.Results:
The survey-weighted cohort represented 5,528,487 HF hospitalizations, of which 7,705 had prior thoracic radiation. Patients with prior TRT were older (73.7 vs 71.4 years), more often female (55.9% vs 45.8%), and had a higher comorbidity burden. Prior TRT was not associated with an increase in in-hospital mortality in propensity-matched analysis (aOR 1.29; 95% CI: 0.87–1.92; p=0.198). TRT exposure was associated with significantly higher palliative care consultation (aOR 2.17; 95% CI: 1.66–2.82; p<0.001) and DNR documentation (aOR 1.37; 95% CI: 1.14–1.63; p=0.001). Prior TRT was associated with lower acute kidney injury (aOR 0.71; 95% CI: 0.61–0.83; p<0.001). There were no significant differences in cardiogenic shock, mechanical ventilation, or LOS. In the restricted analysis, radiation-only and chemotherapy-only groups demonstrated similar outcomes.Conclusion:
Among U.S. HF hospitalizations, prior thoracic radiation was not associated with increased in-hospital mortality, possibly reflecting advances in modern radiation techniques, improved cardio-oncology care, and earlier recognition of radiation-associated heart disease. Patients with prior TRT had higher palliative care utilization and DNR documentation, with otherwise comparable inpatient outcomes. These findings suggest TRT influences care patterns more than short-term HF mortality and support tailored cardio-oncology management.