Trends in cardiology follow-up and long-term care for patients who experienced cardiac events after surgery for gynecologic malignancies (490)

Abstract

Objectives: Cardiovascular (CV) disease is a leading cause of mortality in older women, but there is limited data regarding women with gynecologic cancer. Oncologic diagnoses represent an independent elevated risk for CV events, and perioperative cardiac events are associated with a significantly higher risk of long-term CV disease. However, formal co-management or facilitated entry to care are limited between gynecologic oncology and cardiology. We aimed to characterize referral rates for cardiology care and follow-up for women with gynecologic malignancy who experienced perioperative or subsequent CV events. Methods: A retrospective cohort analysis was performed from January 1, 2013, to December 31, 2019, of all patients with gynecologic malignancies who had either a perioperative (within 30 days) or subsequent cardiac event. Events were abstracted from the electronic medical record using ICD codes. Demographic, medical history, comorbid conditions, oncologic course, and event-based data were analyzed using SAS 9.4. Results: One hundred seventy-four patients met the inclusion criteria; 76 (45.3%) had ovarian cancer, 69 (40.0%) had uterine cancer, and 23 (13.7%) had cervical/vulvovaginal cancer. The average age was 67.4 years, 63.0% were White, 35.3% were Black, and 1.2% were Asian. Fifty-four patients had a perioperative CV event. Of these patients, 63.8% were recommended for cardiology referral, and 70.3% had documented follow-up. Total 46.7% of patients received a new chronic CV diagnosis via this pathway. During the follow-up period, 52 patients had a CV event. Of these, 60.5% were recommended for cardiology referral, and 86.3% had documented follow-up. Almost 54.1% received a new chronic CV diagnosis. Of patients who had a perioperative CV event but were not recommended for cardiology follow-up, 29.4% had a subsequent CV event. Conclusions: As the survivorship of women with gynecologic malignancies improves, the interactions between oncologic care and CV health represent an opportunity to improve collaboration. Approximately half of the patients with perioperative or followup CV events were diagnosed with an underlying CV condition. Approximately one-third of patients who did not receive follow-up at the first event experienced a second event. Establishing a pathway for care may decrease the rate of these events and prevent morbidity. Furthermore, increasing evidence suggests that these events impact oncologic outcomes and overall mortality. Objectives: Cardiovascular (CV) disease is a leading cause of mortality in older women, but there is limited data regarding women with gynecologic cancer. Oncologic diagnoses represent an independent elevated risk for CV events, and perioperative cardiac events are associated with a significantly higher risk of long-term CV disease. However, formal co-management or facilitated entry to care are limited between gynecologic oncology and cardiology. We aimed to characterize referral rates for cardiology care and follow-up for women with gynecologic malignancy who experienced perioperative or subsequent CV events. Methods: A retrospective cohort analysis was performed from January 1, 2013, to December 31, 2019, of all patients with gynecologic malignancies who had either a perioperative (within 30 days) or subsequent cardiac event. Events were abstracted from the electronic medical record using ICD codes. Demographic, medical history, comorbid conditions, oncologic course, and event-based data were analyzed using SAS 9.4. Results: One hundred seventy-four patients met the inclusion criteria; 76 (45.3%) had ovarian cancer, 69 (40.0%) had uterine cancer, and 23 (13.7%) had cervical/vulvovaginal cancer. The average age was 67.4 years, 63.0% were White, 35.3% were Black, and 1.2% were Asian. Fifty-four patients had a perioperative CV event. Of these patients, 63.8% were recommended for cardiology referral, and 70.3% had documented follow-up. Total 46.7% of patients received a new chronic CV diagnosis via this pathway. During the follow-up period, 52 patients had a CV event. Of these, 60.5% were recommended for cardiology referral, and 86.3% had documented follow-up. Almost 54.1% received a new chronic CV diagnosis. Of patients who had a perioperative CV event but were not recommended for cardiology follow-up, 29.4% had a subsequent CV event. Conclusions: As the survivorship of women with gynecologic malignancies improves, the interactions between oncologic care and CV health represent an opportunity to improve collaboration. Approximately half of the patients with perioperative or followup CV events were diagnosed with an underlying CV condition. Approximately one-third of patients who did not receive follow-up at the first event experienced a second event. Establishing a pathway for care may decrease the rate of these events and prevent morbidity. Furthermore, increasing evidence suggests that these events impact oncologic outcomes and overall mortality.