Developing a Cardiology-Oncology Partnership

Developing a Cardiology-Oncology Partnership

Cardiovascular disease (CVD) and cancer are the most prevalent diseases in the current era, and the rates of these diseases continue to rise. More than 2 million breast cancer survivors in the United States are at risk for cardiotoxicity. Pediatric cancer survivors are two to five times more likely than the general population to develop heart disease. Treatment for cancer has become more effective, but cardiac disease in these patients has in turn become increasingly common. CVD can affect their quality of life as well as the course of cancer treatment. Preventing CVD in Cancer Patients Preventing CVD in cancer patients is important because aggressive cancer therapies are being used in older patients who may have cardiac problems or cardiovascular risk factors. Furthermore, researchers are identifying cardiac toxicities with new cancer therapies. Cardiotoxicity from cancer treatments include heart failure, hypertension, hypotension, arrhythmias, pericarditis, and myocardial ischemia. Radiation to the chest, leukemias, and chest tumors can lead to pericarditis, myocarditis, valve disease, and coronary artery disease.   Diagnosing cardiotoxicity during cancer treatment can be challenging. Symptoms like fatigue, shortness of breath, and edema are common to cardiac problems but are also adverse effects of cancer therapy. When patients present with these symptoms, they should be referred to cardio-oncology programs for further evaluation. Collaborative Care Among Cardiologists & Oncologists At the University of Michigan, cardiologists are collaborating with oncologists to tailor cardiac and cancer therapy to minimize cardiotoxicity. We stratify risk in patients with cardiac disease or CVD risk factors in an effort to optimize these conditions prior to cancer treatment. Cardio-oncology programs: • Provide prevention and early detection of cardiac complications....

Managing Recent-Onset Atrial Fibrillation in the ED

Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance. AF is a risk factor for ischemic stroke and heart failure, both of which represent significant public health problems. With an increasing prevalence among an aging population, symptomatic AF-related ED visits have been rising and will likely continue to rise. Traditionally, ED patients thought to have recent-onset AF have been hospitalized for monitoring and evaluation of more serious conditions. More recently, clinicians have been utilizing a more aggressive approach in which stable ED patients with presumed recent-onset AF are treated with elective cardioversion without anticoagulation. While previous reports suggest that this approach is associated with a high rate of cardioversion to sinus rhythm and a low rate of hospitalization and complications, there is no consensus on whether it is better than traditional approaches. Seeking Confirmation on Recent-Onset AF Treatment In the February 2012 Journal of Emergency Medicine, David R. Vinson, MD, and colleagues published a prospective multicenter study that describes the management of ED patients with presumed recent-onset AF. “It had been our anecdotal experience at three affiliated community EDs that taking an aggressive cardioversion approach to managing patients with recent-onset AF was effective and associated with few complications,” says Dr. Vinson. “In this study, we put our practice patterns under critical scrutiny to confirm the safety and effectiveness of ED cardioversion and to accurately measure the incidence of thromboembolism 30 days after discharge.” “Clinicians who are already practicing a more aggressive approach to restoring sinus rhythm can be reassured by the safety and efficacy that was observed in our study.” Dr. Vinson and colleagues analyzed 206 patients...