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Initial Five Years Experience of the Ottawa Hospital Cardio-Oncology Clinic: Patient Characteristics & Clinical Outcomes
Abstracts METHODS:
A retrospective cohort study was performed on consecutive patients with a primary diagnosis of HF discharged from two independent acute care wards in the Saskatoon Health Region between January and June 2012. Patients discharged from a cardiology ward received regular telephone follow-up via the TelASK program, while clinical teaching unit patients did not. Patients were excluded if they died in hospital, left hospital against medical advice or resided outside the health region. The primary outcomes were HF-related readmissions and all-cause mortality at 6 months following discharge. Medication adherence and all-cause readmission were secondary outcomes. RESULTS: Ninety-four patients were enrolled in the study - 54 received TelASK follow-up; 40 did not. Baseline characteristics were similar in both cohorts with the exception of age. Overall mortality was not significantly different between groups. However, a trend was observed towards increased HF-related hospitalizations among the clinical teaching unit cohort compared to the TelASK cohort (adjusted HR 2.23, 95% CI 0.94 - 5.29; p ¼ 0.068) (figure 1). There was also a trend towards increased all-cause readmissions in the clinical teaching unit cohort compared to the TelASK cohort (adjusted HR 1.56, 95% CI 0.82 - 2.97; p ¼ 0.173). Patient adherence, defined as a medication possession ratio of greater than 0.8, did not differ between groups. However, an association may be present between adherence and HF readmission (OR ¼ 2.6, p ¼ 0.12). CONCLUSION: The TelASK program did not significantly affect mortality, readmission or medication adherence rates in this study. However, there was a trend towards reduced HF-related and all-cause readmission rates. Among a small cohort of individuals hospitalized for HF, post-discharge care using the TelASK telephone follow-up program may be a cost-effective strategy to reduce the burden of HF readmissions through a mechanism other than medication adherence. Further studies are required to confirm these preliminary findings.
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281 INITIAL FIVE YEARS EXPERIENCE OF THE OTTAWA HOSPITAL CARDIO-ONCOLOGY CLINIC: PATIENT CHARACTERISTICS & CLINICAL OUTCOMES CB Johnson, M Turek, A Law, E Stadnick, S Hopkins, N Graham, FL Dattilo, S Dent Ottawa, Ontario BACKGROUND: In 2008, we established a multidisciplinary cardiac oncology clinic (COC) to facilitate rapid diagnosis and treatment of cardiotoxicity due to cancer therapy (CT). The initial focus of this clinic pertained to women with early stage breast cancer exposed to chemotherapy +/trastuzumab, but the widespread adoption of targeted therapies has led to referral of a much broader patient population. METHODS: Cancer patients receiving CT at our centre referred to the COC beginning 10/08 until 09/12. Data included: patient demographics, type of cancer, CT, reason for referral, cardiac treatment and outcomes. RESULTS: 405 patients (243 breast, 56 gastrointestinal, 46 genitourinary, 28 hematological, 15 lung, 17 other); male/ female (114; 291), median age 60 years (r: 18-90) with early stage disease (ESD) (225), advanced stage disease (139), hematologic disease (28), and unknown stage (13). 356 (88%) patients referred were exposed to cancer therapy (205 anthracyclines, 161 monoclonal antibodies, 30 tyrosine kinase inhibitors). Reasons for referral included: decreased LVEF (147; 37%), pre-CT assessment (57; 14%), arrhythmia (37; 9%), hypertension (22; 5%), CHF symptoms (17; 4%), cardiomyopathy (15; 4%), and other (110; 27%). 152 (38%) patients received cardiac medications (35 ace inhibitor (ACEI) alone, 20 beta blocker (BB) alone, 16 ACEI and BB, 81 other cardiac drug combinations). Of 277 (68%) patients receiving CT at time of referral to the COC, 124 (45%) successfully completed treatment (10% post cardiac-related delays; 35% no cardiac-related delays), 39% discontinued current therapy (14% due to cardiac toxicity) and 16% are ongoing CT. As of September 2012, 50 patients were deceased (42 progression, 5 cardiac related, 3 unknown). CONCLUSION: This observational study reports on clinical outcomes of patients referred to a dedicated COC. A substantial number of patients were able to continue CT while undergoing surveillance for potential cardiotoxicity in this clinic. The data derived from this clinic will will help develop strategies to manage the unique cardiovascular problems presented by cancer patients.
A retrospective cohort study was performed on consecutive patients with a primary diagnosis of HF discharged from two independent acute care wards in the Saskatoon Health Region between January and June 2012. Patients discharged from a cardiology ward received regular telephone follow-up via the TelASK program, while clinical teaching unit patients did not. Patients were excluded if they died in hospital, left hospital against medical advice or resided outside the health region. The primary outcomes were HF-related readmissions and all-cause mortality at 6 months following discharge. Medication adherence and all-cause readmission were secondary outcomes. RESULTS: Ninety-four patients were enrolled in the study - 54 received TelASK follow-up; 40 did not. Baseline characteristics were similar in both cohorts with the exception of age. Overall mortality was not significantly different between groups. However, a trend was observed towards increased HF-related hospitalizations among the clinical teaching unit cohort compared to the TelASK cohort (adjusted HR 2.23, 95% CI 0.94 - 5.29; p ¼ 0.068) (figure 1). There was also a trend towards increased all-cause readmissions in the clinical teaching unit cohort compared to the TelASK cohort (adjusted HR 1.56, 95% CI 0.82 - 2.97; p ¼ 0.173). Patient adherence, defined as a medication possession ratio of greater than 0.8, did not differ between groups. However, an association may be present between adherence and HF readmission (OR ¼ 2.6, p ¼ 0.12). CONCLUSION: The TelASK program did not significantly affect mortality, readmission or medication adherence rates in this study. However, there was a trend towards reduced HF-related and all-cause readmission rates. Among a small cohort of individuals hospitalized for HF, post-discharge care using the TelASK telephone follow-up program may be a cost-effective strategy to reduce the burden of HF readmissions through a mechanism other than medication adherence. Further studies are required to confirm these preliminary findings.
S199
281 INITIAL FIVE YEARS EXPERIENCE OF THE OTTAWA HOSPITAL CARDIO-ONCOLOGY CLINIC: PATIENT CHARACTERISTICS & CLINICAL OUTCOMES CB Johnson, M Turek, A Law, E Stadnick, S Hopkins, N Graham, FL Dattilo, S Dent Ottawa, Ontario BACKGROUND: In 2008, we established a multidisciplinary cardiac oncology clinic (COC) to facilitate rapid diagnosis and treatment of cardiotoxicity due to cancer therapy (CT). The initial focus of this clinic pertained to women with early stage breast cancer exposed to chemotherapy +/trastuzumab, but the widespread adoption of targeted therapies has led to referral of a much broader patient population. METHODS: Cancer patients receiving CT at our centre referred to the COC beginning 10/08 until 09/12. Data included: patient demographics, type of cancer, CT, reason for referral, cardiac treatment and outcomes. RESULTS: 405 patients (243 breast, 56 gastrointestinal, 46 genitourinary, 28 hematological, 15 lung, 17 other); male/ female (114; 291), median age 60 years (r: 18-90) with early stage disease (ESD) (225), advanced stage disease (139), hematologic disease (28), and unknown stage (13). 356 (88%) patients referred were exposed to cancer therapy (205 anthracyclines, 161 monoclonal antibodies, 30 tyrosine kinase inhibitors). Reasons for referral included: decreased LVEF (147; 37%), pre-CT assessment (57; 14%), arrhythmia (37; 9%), hypertension (22; 5%), CHF symptoms (17; 4%), cardiomyopathy (15; 4%), and other (110; 27%). 152 (38%) patients received cardiac medications (35 ace inhibitor (ACEI) alone, 20 beta blocker (BB) alone, 16 ACEI and BB, 81 other cardiac drug combinations). Of 277 (68%) patients receiving CT at time of referral to the COC, 124 (45%) successfully completed treatment (10% post cardiac-related delays; 35% no cardiac-related delays), 39% discontinued current therapy (14% due to cardiac toxicity) and 16% are ongoing CT. As of September 2012, 50 patients were deceased (42 progression, 5 cardiac related, 3 unknown). CONCLUSION: This observational study reports on clinical outcomes of patients referred to a dedicated COC. A substantial number of patients were able to continue CT while undergoing surveillance for potential cardiotoxicity in this clinic. The data derived from this clinic will will help develop strategies to manage the unique cardiovascular problems presented by cancer patients.