Risk stratification according to the ESC Cardio Oncology Guideline 2022 and its impact on patient care

Sebastian Welf Romann (Heidelberg)1, N. Frey (Heidelberg)1, L. H. Lehmann (Heidelberg)1

1Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland



The evolving landscape of cardio-oncology underscores the critical importance of structured follow-up protocols in monitoring cancer patients undergoing cardiovascular interventions. In the wake of the recently updated 2022 European Society of Cardiology (ESC) Cardio-Oncology Guideline, there arises a pivotal need to investigate the recommended frequency and modalities of follow-up assessments. The guideline, shaped by advancements in both oncologic and cardiovascular care, aims to provide a guidance for the surveillance and management of cardiovascular complications in cancer patients. 



We aimed to explore the implications of the recommended surveillance strategies outlined in the 2022 ESC Cardio-Oncology Guideline, shedding light on their practical implementation.



Patients admitted to the cardio-oncology unit at the University Hospital Heidelberg  between December 2022 and September 2023 were examined and prospectively allocated to risk groups according the 2022 ESC Cardio-Oncology Guideline. The combination of risk group and cancer therapy were used to calculate the estimated follow up work and visits for each patient. 



236 baseline stratifications were collected. The most prevalent therapies include HER2-targeted therapies (73 cases), anthracyclines (55 cases), immune checkpoint-inhibitors (58 cases), RAF/MEK inhibitors (25 cases),VEGF Inhibitor (16 cases), BCR-ABL inhibitors (3 cases), and multiple myeloma therapies (6 cases). These therapies were assigned to Low Risk (99 cases), Medium Risk (44 cases), High Risk (57 cases), and Very High Risk (36 cases). 

According to 2022 ESC Cardio-Oncology Guideline these 236 patients sum up to a minimum of 944 echocardiographies and 1337 determination of cardiac biomarkers during the time of their planned cancer therapy and a maximum of 12 months of follow-up. 



The anticipated demands for cardiovascular monitoring, as suggested by the ESC guidelines, underscore the critical need for vigilant surveillance in this cohort. The scale of the necessary cardiovascular assessments is substantial and emphasizes the balance required in cardio-oncology care, navigating between the imperative to monitor cardiovascular health and the practical challenges posed by the frequency and intensity of the recommended assessments. Further analysis will focus on cardiovascular events and outcome in this real-world cohort. 



Cardio-oncology, Cardiotoxicity, Cancer survivors, Risk stratification


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