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Cardiac risk stratification of breast cancer patients in a cardio-oncology clinic

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

The field of cardio-oncology aims to optimize the cardiac health of cancer patients. The goals of this study are to (1) describe the demographics of a cardio-oncology clinic and (2) apply the American Society of Clinical Oncology (ASCO) cardiac risk stratification guidelines among breast cancer patients to assess the development of cardiovascular events, primarily heart failure (HF).

Methods

We performed a retrospective chart review on 203 consecutive cardio-oncology patients who were seen between January 2019 and March 2020. Mean follow-up for the cohort was 29.2 ± 3.1 months (range 0–113). We applied the ASCO guidelines to the breast cancer subgroup.

Results

The plurality of patients 82/203 (40%) referred to clinic had breast cancer. The most common reason for referral was asymptomatic left ventricular (LV) dysfunction or HF (40%). Only 36/203 (18%) of patients were referred for a pre-chemotherapy evaluation. In breast cancer patients, there was a trend toward significance in up-titrating or initiating beta-blockers in the high vs. low risk ASCO groups [46/69 (67%) vs. 5/13 (38%), p = 0.054]. Approximately 13/82 (16%) of breast cancer patients required alterations to their anti-cancer therapy. HF events occurred in 1/36 (3%) of cancer treatment naïve patients and 14/167 (8%) of those with prior therapy, specifically 9% of the breast cancer subset.

Conclusion

Our study provides insight into referral practices, interventions, and outcomes at a cardio-oncology clinic. Furthermore, breast cancer patients continue to have high rates of HF. These findings suggest a need to shift referral practices upstream for a pre-chemotherapy evaluation to optimize cardiovascular health.

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Authors and Affiliations

  1. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Peter G. Doukas, Ruchi N. Patel & Vishnu Venkatesh

  2. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Sadiya S. Khan, Abigail Baldridge & Nausheen Akhter

  3. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Sadiya S. Khan

  4. Division of Cardiovascular Medicine, Northwestern University Feinberg School of Medicine, 676 N St. Clair, Suite 600, Chicago, IL, 60611, USA

    Nausheen Akhter

Authors
  1. Peter G. Doukas
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  2. Ruchi N. Patel
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  3. Vishnu Venkatesh
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  4. Sadiya S. Khan
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  5. Abigail Baldridge
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  6. Nausheen Akhter
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Contributions

PGD and NA designed the study. PGD, RNP, and VV collected the clinical data, created the figures, and created the tables. PGD, RNP, VV, SSK, AB, and NA wrote and edited the manuscript.

Corresponding author

Correspondence to Nausheen Akhter.

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Doukas, P.G., Patel, R.N., Venkatesh, V. et al. Cardiac risk stratification of breast cancer patients in a cardio-oncology clinic. Breast Cancer Res Treat 190, 133–142 (2021). https://doi.org/10.1007/s10549-021-06353-x

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  • DOI: https://doi.org/10.1007/s10549-021-06353-x

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