Evaluation and management of cancer patients presenting with acute cardiovascular disease: a Clinical Consensus Statement of the Acute CardioVascular Care Association (ACVC) and the ESC council of Cardio-Oncology—part 2: acute heart failure, acute myocardial diseases, acute venous thromboembolic diseases, and acute arrhythmias

Gevaert, Sofie; Halvorsen, Sigrun; Sinnaeve, Peter; Sambola, Antonia; Gulati, Geeta; Lancellotti, Patrizio; Meer, Peter van der; Lyon, Alexander R.; Farmakis, Dimitrios; Lee, Geraldine; Boriani, Giuseppe; Wechalekar, Ashutosh; Okines, Alicia; Asteggiano, Riccardo; Pfister, Roman; Bergler‐Klein, Jutta; Lettino, Maddalena

doi:10.1093/ehjacc/zuac107

Cited by 16 publications

(10 citation statements)

References 68 publications

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“…30 Despite the lack of dedicated trials, there are data on NOACs derived from post hoc analysis of randomized trials and observational studies showing that NOACs are the drugs of choice for long-term anticoagulation in cancer, with lowmolecular weight heparin preferred in the active phase of cancer (cancer diagnosed within the previous 6 months). 31,32 We report that OAC prescribing patterns may differentially vary by age; for example, in certain age groups (55-64, 65-74, and 75- These findings are consistent with previous data from the United…”

Section: Discussionsupporting

confidence: 91%

“…This is because NOACs might be a preferred option over warfarin in patients with cancer because they do not require frequent INR monitoring and have fewer drug–drug or food–drug interactions 30 . Despite the lack of dedicated trials, there are data on NOACs derived from post hoc analysis of randomized trials and observational studies showing that NOACs are the drugs of choice for long‐term anticoagulation in cancer, with low–molecular weight heparin preferred in the active phase of cancer (cancer diagnosed within the previous 6 months) 31,32 …”

Section: Discussionmentioning

confidence: 99%

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Oral anticoagulant prescribing among patients with cancer and atrial fibrillation in England, 2009–2019

Ajabnoor,

Parisi,

Zghebi

et al. 2023

Cancer

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BackgroundAnticoagulation of patients with atrial fibrillation (AF) and cancer is challenging because of their high risk for stroke and bleeding. Little is known of the variations of oral anticoagulant (OAC) prescribing in patients with AF with and without cancer.MethodsPatients with first‐time AF during 2009–2019 from the Clinical Practice Research Datalink were included. Cancer diagnosis was defined as a history of breast, prostate, colorectal, lung, or hematological cancer. Competing‐risk analysis was used to assess the risk of OAC prescribing in patients with AF and cancer adjusted for clinical and sociodemographic factors.ResultsOf 177,065 patients with AF, 11.7% had cancer. Compared to patients without cancer, patients with cancer were less likely to receive OAC: prostate cancer (subhazard ratio [SHR], 0.95; 95% CI, 0.91–0.99), breast cancer (SHR, 0.93; 95% CI, 0.89–0.98), colorectal cancer (SHR, 0.93; 95% CI, 0.88–0.99), hematological cancer (SHR, 0.70; 95% CI, 0.65–0.75), and lung cancer (SHR, 0.44; 95% CI, 0.38–0.50). The cumulative incidence function (CIF) of OAC prescribing was lowest for patients with lung cancer and hematological cancer compared with patients without cancer. The difference between the CIF of OAC prescribing in patients with and without cancer becomes narrower in the most deprived areas. Elderly patients (aged ≥85 years) overall had the lowest CIF of OAC prescribing regardless of cancer status.ConclusionsIn patients with AF, underprescribing of OAC is independently associated with certain cancer types. Patients with hematological and lung cancer are the least likely to receive anticoagulation therapy compared with patients without cancer. Underprescribing of OAC in cancer is linked to old age. Further studies of patients with AF and cancer are warranted to assess the net clinical benefit of anticoagulation in certain cancer types.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Oral anticoagulant prescribing among patients with cancer and atrial fibrillation in England, 2009–2019

Ajabnoor,

Parisi,

Zghebi

et al. 2023

Cancer

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“…The complexity of the acute cardiovascular presentations from cytotoxic, targeted and immunotherapies necessitates cooperation between various specialists to ensure holistic delivery of care that aims to identify and mitigate the risks of cardiovascular complications during and after cancer therapy. [1][2][3] The greater numbers of cancers that are treated with cardiotoxic therapies, alongside the better screening for cancer therapy-related cardiovascular toxicity (CTR-CVT), create a need to develop tools to measure the quality of cardio-oncology care and capture outcomes.…”

Section: Introductionmentioning

confidence: 99%

European Society of Cardiology quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity in cancer treatment

Lee

Aktaa

Baker

et al. 2022

European Heart Journal - Quality of Care and Clinical Outcomes

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Aims To develop quality indicators (QIs) for the evaluation of the prevention and management of cancer therapy-related cardiovascular toxicity. Methods and results We followed the European Society of Cardiology (ESC) methodology for QI development which comprises (i) identifying the key domains of care for the prevention and management of cancer therapy-related cardiovascular toxicity in patients on cancer treatment, (ii) performing a systematic review of the literature to develop candidate QIs, and (iii) selecting of the final set of QIs using a modified Delphi process. Work was undertaken in parallel with the writing of the 2022 ESC Guidelines on Cardio-Oncology and in collaboration with the European Haematology Association, the European Society for Therapeutic Radiology and Oncology and the International Cardio-Oncology Society. In total, 5 main and 9 secondary QIs were selected across five domains of care: (i) Structural framework, (ii) Baseline cardiovascular risk assessment, (iii) Cancer therapy related cardiovascular toxicity, (iv) Predictors of outcomes, and (v) Monitoring of cardiovascular complications during cancer therapy. Conclusion We present the ESC Cardio-Oncology QIs with their development process and provide an overview of the scientific rationale for their selection. These indicators are aimed at quantifying and improving the adherence to guideline-recommended clinical practice and improving patient outcomes.

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“…Hematological patients with such baseline diagnoses are most vulnerable to further severe complications during active cancer therapy. These events have recently been discussed in a consensus published by the experts from the Acute CardioVascular Care Association (ACVC) and the ESC Council of Cardio-Oncology ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Characteristics of patients with newly diagnosed hematological malignancies referred for echocardiography

Kępski,

Szmit,

Lech-Marańda

2024

Front. Oncol.

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ObjectiveThe importance of cardio-hemato-oncology programs is increasing. The main aim of the study was to identify all coexisting cardiovascular disorders in patients with new hematological malignancies referred for echocardiography during baseline evaluation before anticancer therapy.Material and methodsThe study was based on 900 echocardiographic examinations performed within 12 months at the Institute of Hematology and Transfusion Medicine in Poland: 669 tests (74.3%) were dedicated to hemato-oncology patients at the different stages of cancer therapy, however almost a third of the tests (277, 30.8%) were part of a baseline evaluation before starting first line anticancer therapy due to newly diagnosed hematological malignancies.ResultsThe group of 277 patients with new hematological malignancies (138 women, 49.82%) with a median age of 66 years (interquartile range: 53-72 years) was included in the main analyses. The three most frequent new histopathological diagnoses were: non-Hodgkin lymphoma (63 cases; 22.74%), acute myeloid leukaemia (47 cases; 16.97%), and multiple myeloma (45 cases; 16.25%). The three most common clinical cardiology disorders were arterial hypertension (in 133 patients, 48.01%), arrhythmias (48 patients, 17.33%), and heart failure (39 patients, 14.08%). Among 48 patients with arrhythmias there were 22 cases with atrial fibrillation. The most frequently detected echocardiographic abnormality was Left Atrial Volume Index >34 ml/m2 which was present in 108 of 277 patients (38.99%) and associated with a significantly greater chance of concomitant diagnosis of arrhythmias (OR=1.98; p=0.048) especially atrial fibrillation (OR=3.39; p=0.025). The second most common echocardiographic finding was diastolic dysfunction 2nd or 3rd degree revealed in 43 patients (15.52%) and associated with a greater chance of simultaneous diagnosis of heart failure (OR=8.32; p<0.0001) or arrhythmias (OR=4.44; p<0.0001) including atrial fibrillation (OR=5.40; p=0.0003).ConclusionsIn patients with newly diagnosed hematological malignancies left ventricular diastolic dysfunction is a common abnormality in echocardiography and may determine diagnoses of heart failure or arrhythmias.

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Cited by 16 publications

References 68 publications

Oral anticoagulant prescribing among patients with cancer and atrial fibrillation in England, 2009–2019

Oral anticoagulant prescribing among patients with cancer and atrial fibrillation in England, 2009–2019

European Society of Cardiology quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity in cancer treatment

Characteristics of patients with newly diagnosed hematological malignancies referred for echocardiography

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