Management of Chemotherapy-Induced Left Ventricular Dysfunction and Heart Failure in Patients With Cancer While Undergoing Cancer Treatment: The MD Anderson Practice.

Anecita P Fadol

doi:10.3389/fcvm.2018.00024

Abstract

Chemotherapy-induced cardiotoxicity resulting in heart failure (HF) is one of the most dreaded complications of cancer therapy that can significantly impact morbidity and mortality. With a high prevalence of cardiovascular disease in cancer patients, the risk of developing HF is significantly increased. A new discipline of Onco-Cardiology has evolved to address the cardiovascular needs of patients with cancer, however, there is limited evidence-based data to guide clinical decision-making in the management of the cardiovascular complications of cancer therapy. The department of cardiology at MD Anderson Cancer Center initiated the MD Anderson Practice (MAP) project and developed algorithms to guide the management of the cardiovascular complications of cancer therapy. For chemotherapy-induced HF, we initiated the Heart Success Program (HSP), a patient-centered program that promotes interdisciplinary collaboration for the management of concurrent HF resulting from chemotherapy-induced cardiotoxicity. After one year of HSP implementation, compliance with the Center for Medicare and Medicaid Services HF core measures has significantly improved. The measurement of LVEF and initiation of recommended pharmacologic therapy for HF (angiotensin converting enzyme inhibitor [ACE-I] or angiotensin receptor blocker for ACE-I intolerant patients) has improved to 100%; provision of discharge instruction has improved from 50 to 94%; and the 30-day hospital readmission rate decreased from 40 to 27%. This article will describe the MD Anderson Practice in the management of chemotherapy-induced cardiomyopathy and HF in cancer patients through the HSP. The novelty of the HSP has raised clinician’s awareness of the magnitude of the clinical problem of HF in cancer and the

Highlights

Cardiotoxicity resulting in heart failure (HF) is one of the most dreaded complications of cancer therapy that can significantly impact patient care and clinical outcomes
Cancer patients have a high prevalence of baseline cardiovascular risk factors and cardiovascular disease (CVD) prior to initiation of cancer therapy, making them more vulnerable to cardiovascular injuries, which may increase their risk of developing cardiomyopathy leading to HF and death
To promote collaboration among cardiologists, oncologists, nurses and other members of the health care team, we developed the Heart Success Program (HSP) (Figure 2), a patientcentered, interdisciplinary program to coordinate the management of concurrent cardiomyopathy (CMP) and HF while the patient is receiving cancer treatment

Summary

Introduction

Cardiotoxicity resulting in heart failure (HF) is one of the most dreaded complications of cancer therapy that can significantly impact patient care and clinical outcomes. Cancer patients have a high prevalence of baseline cardiovascular risk factors and cardiovascular disease (CVD) prior to initiation of cancer therapy, making them more vulnerable to cardiovascular injuries, which may increase their risk of developing cardiomyopathy leading to HF and death. Over the course of cancer therapy, cancer patients with multiple comorbidities are managed by multidisciplinary teams with a concentrated effort on treating cancer, and the focus on the cardiotoxic effects of cancer treatments may be minimalized which can result in adverse cardiac outcomes and unplanned hospitalizations. There is limited evidence-based data to guide clinical decision-making in many areas of Onco-Cardiology, a number of documents attempting to define best practices from national societies is increasing [6,7,8,9].Because cancer patients are often excluded from cardiology trials, purely evidence-based data in the management of the cardiac complications of cancer therapy is almost impossible. A pre-existing cardiovascular risk factor is itself a strong predictor for the development of cardiovascular injury after chemotherapy, making

The Heart Success Program

Timely Initiation of Pharmacologic Therapy for Heart Failure

Outcomes Measurement

Findings

Conclusion