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CV care found lacking in patients with cancer, decreased LVEF
Yoon G. J Am Coll Cardiol. 2010;56:1644-1650.
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Most patients with cancer and asymptomatic decreased left ventricular ejection fraction did not receive ACE inhibitor or angiotensin receptor blocker therapy consistent with American College of Cardiology and American Heart Association guidelines, whereas therapy among those with decreased left ventricular ejection fraction was only moderately improved in comparison.
The study included patients (n=974) who received anthracycline and/or trastuzumab (Herceptin, Genentech) cancer therapy at Stanford University from Oct. 1, 2005, to Oct. 31, 2007. Researchers analyzed chemotherapy regimens, imaging results, cardiac risk factors, concomitant medications and cardiology consultations. They defined decreased LVEF as less than 55%.
Of the 88 patients who met exclusion criteria, mean baseline LVEF was 60 ± 8%, with 14% of patients having decreased LVEF. After anthracycline and/or trastuzumab therapy, decreased LVEF rose to 40% of the patients. In this patient population, 40% received ACE inhibitor or angiotensin receptor blocker therapy, 51% beta-blocker therapy and 54% cardiology consultation.
Among patients (n=26) with asymptomatic decreased LVEF, 31% received ACE and/or angiotensin receptor blocker therapy, 35% received beta-blocker therapy and 42% received cardiology consultation.
These findings led the researchers to conclude that many cancer survivors are not receiving treatment consistent with HF guidelines. “This suggests that closer collaboration between cardiologists and oncologists is needed and may have implications for the prevention and treatment of CV toxicity among cancer survivors,” they wrote.
Although the reasons for the lack of treatment and referral of patients with asymptomatic decreased LVEF were not evaluated in the study, the researchers proposed that a lack of knowledge of these treatment guidelines by the clinicians and beliefs among physicians that these declines in cardiac function are transient and reversible may be possible explanations.
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