Hospital-Level Effects on Cardiovascular Monitoring Among Cancer Patients Treated with Cardio-Toxic Therapies
Author(s)
Pei-Lin Huang, MHS1, Manu Murali Mysore, MD2, Brian Barr, MD2, Eberechukwu Onukwugha, MSc, PhD1.
1Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA, 2Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
1Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA, 2Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Presentation Documents
OBJECTIVES: Despite guideline recommendations, cardiac surveillance rates remain suboptimal for cancer patients exposed to potentially cardiotoxic treatments (PCT). The role of hospital-level factors in explaining suboptimal monitoring rates is understudied while this information is necessary for a contextualized understanding. We quantified the relationship between hospital-level factors and cardiac monitoring following the initiation of PCT.
METHODS: This study used Surveillance, Epidemiology, and End Results-Medicare patient-level data linked with hospital-level data. We included patients aged 66+ years who received PCT, including anthracycline, anti-HER2 agents, and immune checkpoint inhibitors (ICIs), between 1/1/2014 and 12/31/2018. Patients without a cancer diagnosis in the prior 24 months and hospitals with fewer than two eligible patients were excluded. The study outcome was the 12-month cardiac monitoring rate following PCT, defined as the number of unique visits during which patients underwent at least one cardiac evaluation, whether for diagnostic or screening purpose, including echocardiograms or multigated acquisition scans. Adequate monitoring was defined as 4+ visits. A multilevel regression model with random intercept was used to estimate incidence rate ratios.
RESULTS: A total of 2,134 patients was identified. The mean age was 74 years (SD=6). 89% were White, 6% were Black and 5% were Asian or Pacific Islander. Overall, 10% of patients received adequate monitoring within one year. Among those treated with anti-HER2 therapy, anthracyclines, and ICIs, the proportions receiving adequate monitoring were 34%, 7%, and 4%, respectively. Hospital-level factors significantly associated with higher cardiac monitoring rates included for-profit/private hospitals, total beds, intensive care unit beds, surgical ICU beds, total discharges, and the number of providers (e.g., physicians, registered nurses).
CONCLUSIONS: Only 1 in 10 patients exposed to PCT received adequate cardiac monitoring. Hospital characteristics were associated with the cardiac monitoring rate. Given that cancer treatment-induced cardiotoxicity can be prevented or mitigated, coordinated and collaborative institutional efforts are needed to improve cardiac monitoring.
METHODS: This study used Surveillance, Epidemiology, and End Results-Medicare patient-level data linked with hospital-level data. We included patients aged 66+ years who received PCT, including anthracycline, anti-HER2 agents, and immune checkpoint inhibitors (ICIs), between 1/1/2014 and 12/31/2018. Patients without a cancer diagnosis in the prior 24 months and hospitals with fewer than two eligible patients were excluded. The study outcome was the 12-month cardiac monitoring rate following PCT, defined as the number of unique visits during which patients underwent at least one cardiac evaluation, whether for diagnostic or screening purpose, including echocardiograms or multigated acquisition scans. Adequate monitoring was defined as 4+ visits. A multilevel regression model with random intercept was used to estimate incidence rate ratios.
RESULTS: A total of 2,134 patients was identified. The mean age was 74 years (SD=6). 89% were White, 6% were Black and 5% were Asian or Pacific Islander. Overall, 10% of patients received adequate monitoring within one year. Among those treated with anti-HER2 therapy, anthracyclines, and ICIs, the proportions receiving adequate monitoring were 34%, 7%, and 4%, respectively. Hospital-level factors significantly associated with higher cardiac monitoring rates included for-profit/private hospitals, total beds, intensive care unit beds, surgical ICU beds, total discharges, and the number of providers (e.g., physicians, registered nurses).
CONCLUSIONS: Only 1 in 10 patients exposed to PCT received adequate cardiac monitoring. Hospital characteristics were associated with the cardiac monitoring rate. Given that cancer treatment-induced cardiotoxicity can be prevented or mitigated, coordinated and collaborative institutional efforts are needed to improve cardiac monitoring.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD109
Topic
Health Service Delivery & Process of Care
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Oncology