European Society of Cardiology quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity in cancer treatment

Abstract

Aims To develop quality indicators (QIs) for the evaluation of the prevention and management of cancer therapy-related cardiovascular toxicity. Methods and results We followed the European Society of Cardiology (ESC) methodology for QI development which comprises (i) identifying the key domains of care for the prevention and management of cancer therapy-related cardiovascular toxicity in patients on cancer treatment, (ii) performing a systematic review of the literature to develop candidate QIs, and (iii) selecting of the final set of QIs using a modified Delphi process. Work was undertaken in parallel with the writing of the 2022 ESC Guidelines on Cardio-Oncology and in collaboration with the European Haematology Association, the European Society for Therapeutic Radiology and Oncology and the International Cardio-Oncology Society. In total, 5 main and 9 secondary QIs were selected across five domains of care: (i) Structural framework, (ii) Baseline cardiovascular risk assessment, (iii) Cancer therapy related cardiovascular toxicity, (iv) Predictors of outcomes, and (v) Monitoring of cardiovascular complications during cancer therapy. Conclusion We present the ESC Cardio-Oncology QIs with their development process and provide an overview of the scientific rationale for their selection. These indicators are aimed at quantifying and improving the adherence to guideline-recommended clinical practice and improving patient outcomes.

Prevalence of Australians exposed to potentially cardiotoxic cancer medicines: a population-based cohort study

“…A new set of guidelines and quality indicators published in 2022 comprise a significant step towards helping institutions implement recommended care, reduce variation in that care, and quantify the quality of cancer treatment-related cardiac care. 12 , 30 The guidelines note that clearly specified roles for different health professionals (e.g., nurses, specialists) are still needed, and we agree with previous calls for greater integration of primary care practitioners in cardio-oncology care. 31 …”

Cardiovascular outcomes of cancer patients in rural Australia

“…This was additionally reflected in the over representation of modifiable risk factors in our patient group compared to published local risk factor data in cancer patients residing in metropolitan location ( 5 , 15 ) It is established that cancer and heart disease share common risk factors, however the over representation of cardiovascular risk factors in our group demonstrates a clinical imperative to address this disease burden or implement ongoing surveillance, particularly in under-resourced areas ( 16 ). The recent release of the first International Cardio-Oncology treatment guidelines ( 17 ) and quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity ( 18 ) represent exciting progress in clinical care. Our real-world analysis further supports the provision of cardio oncology services and the urgent clinical need to implement guideline-based care to prevent or mitigate adverse cardiac complications in all patients living with and beyond cancer.…”

Temporal trends in guideline‐recommended cardiometabolic testing completeness before initiating immune checkpoint inhibitors: A cohort study

“…The cardiovascular needs of ICI users were addressed by the European Society of Cardiology's (ESC) 2022 Cardio-Oncology Guidelines [4], with cardiometabolic testing recommended before initiating ICIs (pre-ICI), including glycaemic (HbA1c or fasting glucose), lipid, renal and natriuretic peptide testing, electrocardiogram and echocardiography [4]. However, current practices of pre-ICI cardiometabolic testing are undescribed, and ensuring testing completeness may improve cardiovascular outcomes [5]. We thus examined trends in pre-ICI cardiometabolic testing completeness and explored whether such trends influenced cardiovascular outcomes.…”

“…Cardiometabolic testing completeness was estimated by numbers of relevant tests (excluding electrocardiogram/echocardiography as data were unavailable, and natriuretic peptide which was then unavailable in Hong Kong's public healthcare system) within 90/180 days pre‐ICI. Proportions of patients with each test were reported, per ESC's quality indicators [5].…”