Abstract
BackgroundProfessional society guidelines are emerging for cardiovascular care in cancer patients. However, it is not yet clear how effectively the cancer survivor population is screened and treated for cardiomyopathy in contemporary clinical practice. As electronic health records (EHRs) are now widely used in clinical practice, we tested the hypothesis that an EHR-based cardio-oncology registry can address these questions.ObjectiveThe aim of this study was to develop an EHR-based pragmatic cardio-oncology registry and, as proof of principle, to investigate care gaps in the cardiovascular care of cancer patients.MethodsWe generated a programmatically deidentified, real-time EHR-based cardio-oncology registry from all patients in our institutional Cancer Population Registry (N=8275, 2011-2017). We investigated: (1) left ventricular ejection fraction (LVEF) assessment before and after treatment with potentially cardiotoxic agents; and (2) guideline-directed medical therapy (GDMT) for left ventricular dysfunction (LVD), defined as LVEF<50%, and symptomatic heart failure with reduced LVEF (HFrEF), defined as LVEF<50% and Problem List documentation of systolic congestive heart failure or dilated cardiomyopathy.ResultsRapid development of an EHR-based cardio-oncology registry was feasible. Identification of tests and outcomes was similar using the EHR-based cardio-oncology registry and manual chart abstraction (100% sensitivity and 83% specificity for LVD). LVEF was documented prior to initiation of cancer therapy in 19.8% of patients. Prevalence of postchemotherapy LVD and HFrEF was relatively low (9.4% and 2.5%, respectively). Among patients with postchemotherapy LVD or HFrEF, those referred to cardiology had a significantly higher prescription rate of a GDMT.ConclusionsEHR data can efficiently populate a real-time, pragmatic cardio-oncology registry as a byproduct of clinical care for health care delivery investigations.
Highlights
The success of cancer therapies has led to a growing population of cancer survivors, over 17 million in the United States in 2020
Among patients with postchemotherapy left ventricular dysfunction (LVD) or HFrEF, those referred to cardiology had a significantly higher prescription rate of a guideline-directed medical therapy (GDMT)
Hierarchical electronic health records (EHRs) databases harbor rich clinical data with specificity exceeding the information available from flat file claims data because EHR diagnoses are encoded with SNOMED CT instead of claims data that are encoded solely based on International Classification of Diseases, Tenth Revision (ICD-10) codes [5]
Summary
The success of cancer therapies has led to a growing population of cancer survivors, over 17 million in the United States in 2020. Cardio-oncology has emerged as an important multidisciplinary specialty to provide cardiovascular care to the cancer patient. Electronic health records (EHRs) used for day-to-day patient care activities provide a unique repository of aggregate data about this at-risk population [4]. EHR data are accumulated in real time, rather than after a delay for claims submission and processing. These novel information management technologies can handle large-scale health care data more efficiently than traditional approaches for standard registries, which are massive endeavors. Professional society guidelines are emerging for cardiovascular care in cancer patients It is not yet clear how effectively the cancer survivor population is screened and treated for cardiomyopathy in contemporary clinical practice.
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