Breast Cancer Research and Treatment

, Volume 171, Issue 1, pp 181–188 | Cite as

Incidence and risk factors for congestive heart failure in patients with early breast cancer who received anthracycline and/or trastuzumab: a big data analysis of the Korean Health Insurance Review and Assessment service database

  • Jung Yoon Choi
  • Eun Young Cho
  • Yoon Ji Choi
  • Jeong Hyeon Lee
  • Seung Pil Jung
  • Kyu Ran Cho
  • Chul Yong Kim
  • Yeul Hong Kim
  • Kyong Hwa ParkEmail author



We aimed to analyze the incidence, time to occurrence, and congestive heart failure (CHF) risk factors for early breast cancer patients treated with anthracycline (AC)-based chemotherapy and/or trastuzumab (T) therapy in Korea.


We included female patients > 19 years old from the Health Insurance Review and Assessment Service database who had no prior CHF history and had been diagnosed with early breast cancer between January 2007 and October 2016.


We included 83,544 patients in our analysis. In terms of crude incidence for CHF, AC followed by T showed the highest incidence (6.3%). However, 3.1 and 4.2% of the patients had CHF due to AC-based chemotherapy and non-AC followed by T, respectively. The median times to occurrence of CHF were different according to adjuvant treatments, approximately 2 years (701.0 days) in the AC-based chemotherapy group vs 1 year (377.5 days) AC followed by T group. T therapy was associated with earlier development of CHF irrespective of previous chemotherapy, but late risk of CHF 1.2 years after T therapy rapidly decreased in both chemotherapy groups. Multivariate Cox regression analysis revealed that the adjusted hazard ratio for CHF was increased in the group of older patients (≥ 65 years old) who underwent AC followed by T therapy, with Charlson comorbidity index scores of ≥ 2.


Our study showed that neo-/adjuvant chemotherapy using T irrespective of previous chemotherapy (AC or non-AC) was associated with significantly increased risk of CHF compared with AC-based chemotherapy in Korean patients with early breast cancer.


Congestive heart failure Anthracycline Trastuzumab Breast cancer 



The authors thank the support of Korea University Anam Hospital Clinical Trial Center.


This study was funded by a Grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI14C2750).

Compliance with ethical standards

Conflict of interest

The authors indicated no potential conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The institutional review board of Korea University Anam Hospital approved and granted this study a waiver of informed consents from participants.

Supplementary material

10549_2018_4809_MOESM1_ESM.docx (40 kb)
Supplementary material 1 (DOCX 40 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jung Yoon Choi
    • 1
  • Eun Young Cho
    • 2
  • Yoon Ji Choi
    • 1
  • Jeong Hyeon Lee
    • 3
  • Seung Pil Jung
    • 4
  • Kyu Ran Cho
    • 5
  • Chul Yong Kim
    • 6
  • Yeul Hong Kim
    • 1
  • Kyong Hwa Park
    • 1
    Email author
  1. 1.Division of Oncology, Department of Internal MedicineKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea
  2. 2.Department of BiostatisticsKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea
  3. 3.Department of PathologyKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea
  4. 4.Department of General SurgeryKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea
  5. 5.Department of RadiologyKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea
  6. 6.Department of Radiation OncologyKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea

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