Suboptimal Use of Cardioprotective Medications in Patients With a History of Cancer

Untaru, Rossana; Chen, Dongqing; Kelly, C.; May, Austin; Collins, Nicholas; Leitch, James; Attia, John; Proeitto, Anthony M.; Boyle, Andrew; Sverdlov, Aaron L.; Ngo, D.

doi:10.1016/j.jaccao.2020.05.010

Cited by 19 publications

(8 citation statements)

References 4 publications

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“…In our study population there was a high incidence of prior cardiovascular admissions in the cancer treatment group, higher than another recently reported large cardio-oncology registry dataset ( 14 ). This was additionally reflected in the over representation of modifiable risk factors in our patient group compared to published local risk factor data in cancer patients residing in metropolitan location ( 5 , 15 ) It is established that cancer and heart disease share common risk factors, however the over representation of cardiovascular risk factors in our group demonstrates a clinical imperative to address this disease burden or implement ongoing surveillance, particularly in under-resourced areas ( 16 ). The recent release of the first International Cardio-Oncology treatment guidelines ( 17 ) and quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity ( 18 ) represent exciting progress in clinical care.…”

Section: Discussionmentioning

confidence: 65%

Cardiovascular outcomes of cancer patients in rural Australia

Williams

Kaur

Warner

et al. 2023

Front. Cardiovasc. Med.

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BackgroundCancer and heart disease are the two most common health conditions in the world, associated with high morbidity and mortality, with even worse outcomes in regional areas. Cardiovascular disease is the leading cause of death in cancer survivors. We aimed to evaluate the cardiovascular outcomes of patients receiving cancer treatment (CT) in a regional hospital.MethodsThis was an observational retrospective cohort study in a single rural hospital over a ten-year period (17th February 2010 to 19th March 2019). Outcomes of all patients receiving CT during this period were compared to those who were admitted to the hospital without a cancer diagnosis.Results268 patients received CT during the study period. High rates of cardiovascular risk factors: hypertension (52.2%), smoking (54.9%), and dyslipidaemia (38.4%) were observed in the CT group. Patients who had CT were more likely to be readmitted with ACS (5.9% vs. 2.8% p = 0.005) and AF (8.2% vs. 4.5% p = 0.006) when compared to the general admission cohort. There was a statistically significant difference observed for all cause cardiac readmission, with a higher rate observed in the CT group (17.1% vs. 13.2% p = 0.042). Patients undergoing CT had a higher rate of mortality (49.5% vs. 10.2%, p ≤ 0.001) and shorter time (days) from first admission to death (401.06 vs. 994.91, p ≤ 0.001) when compared to the general admission cohort, acknowledging this reduction in survival may be driven at least in part by the cancer itself.ConclusionThere is an increased incidence of adverse cardiovascular outcomes, including higher readmission rate, higher mortality rate and shorter survival in people undergoing cancer treatment in rural environments. Rural cancer patients demonstrated a high burden of cardiovascular risk factors.

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Section: Discussionmentioning

confidence: 65%

Cardiovascular outcomes of cancer patients in rural Australia

Williams

Kaur

Warner

et al. 2023

Front. Cardiovasc. Med.

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“…New successful cancer therapies have resulted in a greater number of survivors, but also have increased cardiovascular disease risks [ 23 , 31 , 32 , 41 ]. Therefore, the challenge remains of supporting physicians and cancer survivors in adopting standard-of-care recommendations into clinical practice, especially for those cancer survivors at highest cardiovascular risk [ 18 , 20 , 40 ]. The use of artificial intelligence has the potential to transform personalized risk assessment options for our patients [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…Assuming 40% consistency with evidence-based recommendations at baseline for both groups [ 18 , 20 , 40 ], we will consider clinical significance at a 50% increase from baseline, which corresponds to 60% consistency with the recommendations. To go from 40% at baseline to 60% in the intervention arm of the trial (i.e., Clinical Decision Aid group) with 80% power requires 97 patients in each group, or 194 total patients.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, management and follow-up of cardiovascular risk for cardio-oncology patients and survivors often differ from that of individuals in the general population with similar cardiovascular risk factors. For example, breast cancer patients at risk for cardiovascular complications are often insufficiently treated with cardioprotective medications and appropriate frequencies of cardiac surveillance imaging [18][19][20]. Several cardio-oncology guidelines, medical society scientific statements, and consensus recommendations have become available in recent years [21][22][23][24][25][26][27][28].…”

Section: Introductionmentioning

confidence: 99%

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Patient similarity and other artificial intelligence machine learning algorithms in clinical decision aid for shared decision-making in the Prevention of Cardiovascular Toxicity (PACT): a feasibility trial design

Brown

Chung²,

Doshi³

et al. 2023

Cardio-Oncology

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Background The many improvements in cancer therapies have led to an increased number of survivors, which comes with a greater risk of consequent/subsequent cardiovascular disease. Identifying effective management strategies that can mitigate this risk of cardiovascular complications is vital. Therefore, developing computer-driven and personalized clinical decision aid interventions that can provide early detection of patients at risk, stratify that risk, and recommend specific cardio-oncology management guidelines and expert consensus recommendations is critically important. Objectives To assess the feasibility, acceptability, and utility of the use of an artificial intelligence (AI)-powered clinical decision aid tool in shared decision making between the cancer survivor patient and the cardiologist regarding prevention of cardiovascular disease. Design This is a single-center, double-arm, open-label, randomized interventional feasibility study. Our cardio-oncology cohort of > 4000 individuals from our Clinical Research Data Warehouse will be queried to identify at least 200 adult cancer survivors who meet the eligibility criteria. Study participants will be randomized into either the Clinical Decision Aid Group (where patients will use the clinical decision aid in addition to current practice) or the Control Group (current practice). The primary endpoint of this study is to assess for each patient encounter whether cardiovascular medications and imaging pursued were consistent with current medical society recommendations. Additionally, the perceptions of using the clinical decision tool will be evaluated based on patient and physician feedback through surveys and focus groups. Summary This trial will determine whether a clinical decision aid tool improves cancer survivors’ medication use and imaging surveillance recommendations aligned with current medical guidelines. Trial registration ClinicalTrials.Gov Identifier: NCT05377320

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“…Furthermore, lack of use of cardioprotective statin therapy was also associated with increased risk of hospitalizations. The lack of appropriate guideline-directed use of statins has been previously reported for cancer survivors, despite the fact that these people have high CVD risk [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Adverse Cardiovascular Events in Cancer Patients Treated with Bevacizumab

Ngo

Williams

Horder

et al. 2020

JCM

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Background: Bevacizumab, a vascular endothelial growth factor (VEGF) monoclonal antibody commonly used for the treatment of various cancers, is often associated with adverse cardiovascular effects such as hypertension, cardiac and cerebral ischemia, thrombosis, and bleeding events. Factors associated with increased risks of adverse cardiovascular effects with bevacizumab have not been intensively studied. In this study, we determined factors associated with hospital admissions due to cardiovascular complications in patients who received bevacizumab for cancer treatment. Methods and Results: We retrospectively collected data for all patients treated with bevacizumab between the 1st January 2016 and the 31st December 2017 at the Hunter New England Local Health District. Patients’ characteristics and their medical history were obtained from hospital electronic medical records. Outcome data were sourced from the Institutional Cardiac and Stroke Outcomes Unit database. A total of n = 230 patients (mean age 65, males n = 124 (53.9%)) were treated with bevacizumab during the study period. N = 28 patients were admitted to hospital for a major cardiovascular-related event. Higher total treatment dose (p < 0.05), concomitant hypertension (p = 0.005), diabetes (p = 0.04), atrial fibrillation (p = 0.03), and lack of use of statin therapy (p = 0.03) were key contributors to hospital admission. Conclusions: Results of our study highlight the fact that patients with concomitant baseline cardiovascular disease/risk factors are at an increased risk of cardiovascular hospitalization related to bevacizumab treatment. Careful baseline cardiovascular assessment may be an essential step to minimize cardiovascular complications.

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Suboptimal Use of Cardioprotective Medications in Patients With a History of Cancer

Cited by 19 publications

References 4 publications

Cardiovascular outcomes of cancer patients in rural Australia

Cardiovascular outcomes of cancer patients in rural Australia

Patient similarity and other artificial intelligence machine learning algorithms in clinical decision aid for shared decision-making in the Prevention of Cardiovascular Toxicity (PACT): a feasibility trial design

Factors Associated with Adverse Cardiovascular Events in Cancer Patients Treated with Bevacizumab

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