Healthcare utilization and costs in cancer therapy-related heart failure: a national inpatient sample analysis

Background: Cancer therapy-related heart failure (CTHF) is an increasingly recognized complication of modern oncologic treatments. While its clinical severity has been described, the impact of CTHF on healthcare utilization and resource burden remains poorly defined. Purpose: To evaluate the impact of CTHF on healthcare utilization, including length of stay and hospitalization costs, compared with non-cancer-related heart failure (NCTHF). Methods: We conducted a retrospective analysis of the National Inpatient Sample (2016–2021), identifying adult female patients with a history of breast cancer hospitalized for acute heart failure. Patients were stratified into CTHF and NCTHF groups. Multivariable regression models were used to assess differences in length of stay, total hospitalization costs, and discharge disposition. Results: Among 47,300 hospitalizations, 1,920 (4.1%) were classified as CTHF. Patients with CTHF had significantly longer hospital stays compared with NCTHF (mean 6.2 vs 5.1 days; p<0.001). CTHF was associated with higher hospitalization costs and increased likelihood of discharge to non-home settings, including skilled nursing facilities and rehabilitation centers (p<0.001 for all). These findings persisted after multivariable adjustment. Conclusion: Cancer therapy-related heart failure is associated with significantly increased healthcare utilization and resource burden compared with non-cancer-related heart failure. These findings highlight the economic and system-level impact of CTHF and support the need for targeted strategies to reduce hospitalization burden in this high-risk population.