Abstract 105: Improving Compliance and Follow-Up for Chemotherapy-Induced Heart Failure in an Urban Underserved Tertiary Hospital

Abstract

Background: Chemotherapy-induced cardiomyopathy and heart failure are major complications of cancer therapy and can result in significant morbidity and mortality. Unfortunately, there is a high risk of poor compliance and loss to follow-up in underserved areas. Objective: Create a pathway to improve detection and management of chemotherapy-induced cardiotoxicity and heart failure in patients undergoing chemotherapy treatment in an urban underserved hospital. Description: The project is performed at Kings County Hospital, a major cancer treatment center in Brooklyn, NY. Our findings indicate that over the past five years, patients with chemotherapy-induced cardiomyopathy were lost to follow-up with outpatient cardiology services. Therefore, we developed and applied a new collaborative protocol for patients who were diagnosed with any cancer undergoing treatment complicated by cardiomyopathy. The protocol is as follows; Firstly, patients are sent for a multigated acquisition (MUGA) scan prior to beginning chemotherapy, and every three months thereafter over the course of their chemotherapy treatment. The reading physician then identifies all patients with a 10% or more reduction in ejection fraction between MUGA scans, and notifies the Heart Health Center at Kings County Hospital to contact the patient with an appointment with cardiology services. At the Heart Health Center, the patient is then counseled on guideline-recommended treatment for heart failure. Further follow up with the nurse practitioner is done for medication reconciliation, education regarding activity, weight monitoring, dietary intake, and warning symptoms for heart failure exacerbations. The patient will receive follow-up with a nutritionist for guideline directed dietary recommendations for heart failure and social work services to ensure appropriate social conditions and support. The oncology service will monitor if the patient has followed up with outpatient cardiology before continuing chemotherapy. If the patient was lost to follow up, oncology will notify the Heart Health Center and assist with providing the patient with an appointment. Conclusions: We aim to improve compliance for follow up and guideline directed management for chemotherapy-induced heart failure in an urban underserved tertiary hospital.