{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:18:36Z","timestamp":1793726316681,"version":"4.6.1"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,10,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Guideline\u2010directed medical therapy (GDMT), including angiotensin receptor\u2010neprilysin inhibitor, angiotensin\u2010converting enzyme inhibitors, beta blockers, mineralocorticoid receptor antagonists, and sodium\u2010glucose cotransporter\u20102 inhibitors, has significantly improved outcomes in patients with heart failure with reduced ejection fraction (HFrEF). We examined whether modern GDMT alters the historically observed parity in mortality between HF and cancer.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">From the TriNetX Global Collaborative Research Network (2015\u20132024), we identified 32\u2009125 patients with HFrEF on GDMT (angiotensin receptor\u2010neprilysin inhibitor or angiotensin\u2010converting enzyme inhibitors, mineralocorticoid receptor antagonists, beta blockers, and sodium\u2010glucose cotransporter\u20102 inhibitors), 403\u2009389 not on full GDMT (not receiving all 4 drugs concurrently), and 2\u2009481\u2009106 with malignant cancers. All\u2010cause mortality was compared between HFrEF and cancer overall and across the most common cancers in men (prostate, colorectal, lung) and women (breast, lung, colorectal) using propensity score matching.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Patients with HFrEF on GDMT with angiotensin receptor\u2010neprilysin inhibitors had significantly better survival than patients with cancer (hazard ratio [HR], 0.44 [95% CI, 0.41\u20130.47];\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001). A survival benefit, though less pronounced, was also seen for GDMT with angiotensin\u2010converting enzyme inhibitors instead of angiotensin receptor\u2010neprilysin inhibitor (HR, 0.62 [95% CI, 0.57\u20130.69];\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001). Patients not on GDMT had higher mortality than patients with cancer (HR, 1.15 [95% CI, 1.13\u20131.17];\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001). Among the most common sex\u2010specific cancers, only patients with prostate and breast cancer had better survival than those with HFrEF on GDMT, whereas patients not on GDMT showed worse outcomes across most cancers, except lung cancer.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In this large real\u2010world analysis, patients with HFrEF on GDMT showed better survival than those with cancer overall and across most sex\u2010specific cancers. Patients not on GDMT experienced worse outcomes, emphasizing the need to optimize treatment in HFrEF.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.125.044046","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T11:16:58Z","timestamp":1758280618000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Comparative Mortality in Heart Failure on Guideline\u2010Directed Medical Therapy Versus Malignant Cancer: A Report From a Global Federated Research Network"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2958-943X","authenticated-orcid":false,"given":"Luca","family":"Monzo","sequence":"first","affiliation":[{"name":"Universit\u00e9 de Lorraine","place":["Nancy, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9200-2729","authenticated-orcid":false,"given":"Guillaume","family":"Baudry","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine","place":["Nancy, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0292-0498","authenticated-orcid":false,"given":"Kevin","family":"Duarte","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine","place":["Nancy, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4832-455X","authenticated-orcid":false,"given":"Gema","family":"Hernandez","sequence":"additional","affiliation":[{"name":"TriNetX Europe NV","place":["St. Martens\u2010Latem, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Denquin","sequence":"additional","affiliation":[{"name":"TriNetX Europe NV","place":["St. Martens\u2010Latem, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7732-0887","authenticated-orcid":false,"given":"Gianluigi","family":"Savarese","sequence":"additional","affiliation":[{"name":"Karolinska Institutet","place":["Stockholm, Sweden"]},{"name":"S\u00f6dersjukhuset; Karolinska Institutet","place":["Stockholm, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3278-2057","authenticated-orcid":false,"given":"Nicolas","family":"Girerd","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine","place":["Nancy, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7331a1"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvac013"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.3506"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-024-01046-6"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1388-9842(00)00141-0"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.110.957571"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.822"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216315626048"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1409077"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31824-9"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad195"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooad035"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1200\/CCI.17.00067"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.04.070"},{"key":"e_1_3_1_16_2","volume-title":"Global Cancer Observatory. 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