Abstract
BACKGROUND: Anthracyclines remain a key treatment for many malignancies but can increase the risk of heart failure or cardiomyopathy. Specific guidelines recommend echocardiography and serum cardiac biomarkers such as BNP (B-type natriuretic peptide) or NT-proBNP (N-terminal proBNP) evaluation before and 6 to 12 months after treatment. Our objective was to evaluate associations between racial and ethnic groups in cardiac surveillance of survivors of cancer after exposure to anthracyclines. METHODS AND RESULTS: Adult patients in the OneFlorida Consortium without prior cardiovascular disease who received at least 2 cycles of anthracyclines were included in the analysis. Multivariable logistic regression was performed to estimate the odds ratios (ORs) and 95% CIs for receiving cardiac surveillance at baseline before anthracycline therapy, 6 months after, and 12 months after anthracycline exposure among different racial and ethnic groups. Among the entire cohort of 5430 pa-tients, 63.4% had a baseline echocardiogram, with 22.3% receiving an echocardiogram at 6 months and 25% at 12 months. Non-Hispanic Black (NHB) patients had a lower likelihood of receiving a baseline echocardiogram than Non-Hispanic White (NHW) patients (OR, 0.75 [95% CI, 0.63–0.88]; P=0.0006) or any baseline cardiac surveillance (OR, 0.76 [95% CI, 0.64–0.89]; P=0.001). Compared with NHW patients, Hispanic patients received significantly less cardiac surveillance at the 6-month (OR, 0.84 [95% CI, 0.72–0.98]; P=0.03) and 12-month (OR, 0.85 [95% CI, 0.74–0.98]; P=0.03) time points, respectively. CONCLUSIONS: There were significant racial and ethnic differences in cardiac surveillance among survivors of cancer at baseline and following anthracycline-based treatment in NHB and Hispanic cohorts. Health care providers need to be cognizant of these social inequities and initiate efforts to ensure recommended cardiac surveillance occurs following anthracyclines.
Original language | English (US) |
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Article number | e027981 |
Journal | Journal of the American Heart Association |
Volume | 12 |
Issue number | 10 |
DOIs | |
State | Published - May 16 2023 |
Funding
Dr DeRemer has received consulting fees from Bristol Myers Squibb and reports spousal employment at Sanofi, all unrelated to this study. Dr Guha is supported by the American Heart Association Strategically Focused Research Network Grant in Disparities in Cardo-Oncology, National Institutes of Health/National Heart, Lung, and Blood Institute, and the American Heart Association (AHA #856917), and has received consulting fees from Pfizer unrelated to this study. Dr. Ahmad was supported by grants from the National Institutes of Health/National Heart, Lung, and Blood Institute and the American Heart Association. He has recieved consulting fees from Teladox Livingo and Pfizer unrelated to this study. Dr Fradley reports research grant support from Medtronic and consulting fees from Abbott, AstraZeneca, Myovyant, Takeda, and Zoll. Dr Pepine has received research support from This project was supported through funding by the University of Florida Clinical and Translational Science Institute (CTSI) to Dr Gong. BioCardia, Caladrius, Gatorade Foundation, McJunkin Family Foundation Trust, Mesoblast, Patient-Centered Outcomes Research Institute, National Heart, Lung, and Blood Institute, Pfizer, Sanofi, University of Florida Clinical and Translational Science Institute, US Department of Defense, XyloCor Therapeutics, and the National Institutes of Health; he has served as a consultant for AbbVie, Akros, BioCardia, BloomerTech, Caladrius, Imbria Pharmaceuticals, Ironwood Pharmaceuticals, Milestone Pharmaceuticals, Verily Life Sciences, LLC., and XyloCor Therapeutics and is the editor-in-chief for American Heart Journal Plus (Elsevier) and chief medical editor for Cardiology Today (SLACK/Healio). Dr Gong was supported, in part, from funding from the National Institutes of Health (R01HL151659, R56DE030538, R01HG011800, R01HL149752, and R01HD071779). The remaining authors have no disclosures to report.
Keywords
- anthracyclines
- health disparities
- surveillance
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine