Professional society guidelines are emerging for cardiovascular care in cancer patients. How effectively the cancer survivor population is screened and treated for cardiomyopathy in contemporary clinical practice remains unclear. As EHRs are now widely used in clinical practice, we tested the hypothesis whether an EHR-based cardio-oncology registry can address these questions.
To develop an electronic health records (EHR)-based pragmatic cardio-oncology registry and, as proof of principle, to investigate care gaps in cardiovascular care of cancer patients.
We generated programmatically a de-identified, real-time, EHR-based cardio-oncology registry from all patients in our institutional Cancer Population Registry (n=8275, 2011-2017). We investigated: 1) left ventricular ejection fraction (LVEF) assessment before and after treatment with potentially cardiotoxic agents, and 2) guideline-directed medical therapy (GDMT) for left ventricular dysfunction (LVD), defined as LVEF<50%, and symptomatic heart failure with reduced LVEF (HFrEF), defined as LVEF<50% and problem list documentation of systolic congestive heart failure or dilated cardiomyopathy.
Rapid development of an EHR-based cardio-oncology registry was feasible. Identification of tests and outcomes was similar by EHR-based cardio-oncology registry and manual chart abstraction (100% sensitivity and 83% specificity for LVD). LVEF was documented prior to initiation of cancer therapy in 19.8% of patients. Prevalence of post-chemotherapy LVD and HFrEF was relatively low (9.4% and 2.5%, respectively). Among patients with post-chemotherapy LVD or HFrEF, those referred to cardiology had significantly higher prescription of GDMT.
EHR data can efficiently populate a real-time, pragmatic cardio-oncology registry as a byproduct of clinical care for healthcare delivery investigation.