Abstract 280: Cardiologist Consultation and Associated Outcomes for Older Women with Heart Failure after Breast Cancer Therapy
Background: Commonly employed breast cancer therapies can cause cardiomyopathy (CM) and heart failure (HF). Whether breast cancer patients who subsequently develop HF/CM are treated by cardiologists, and whether this is associated with higher use of guideline-recommended treatments for HF/CM is unknown.
Methods: We used data from SEER-Medicare to identify women with early stage breast cancer diagnosed 2000-2009 who received potentially cardiotoxic adjuvant therapy (anthracyclines, trastuzumab) and developed HF/ CM. We assessed the frequency of consultation or office visit with a cardiologist within 90 days of HF/CM (as ascertained by diagnostic billing codes). Using Medicare Part D pharmacy claims (available 2006-2011, N=177), we assessed differences in use of guideline-recommended treatments (angiotensin converting enzyme [ACE]-inhibitors, angiotensin-receptor blockers [ARBs] and beta-blockers specifically indicated for HF/CM) stratified by cardiology consultation using χ2 test. We compared differences in survival after HF/CM stratified by cardiology consultation using the log-rank test.
Results: We identified 1028 older women with stage I-III breast cancer diagnosed between 2000 and 2009 who developed HF/CM in the 3 years after adjuvant cancer therapy. Mean patient age was 73.1 years (standard deviation=4.8); 71%received anthracyclines alone, 17%received trastuzumab alone, and 12% received both. There were 345 (34%) women seen by a cardiologist within 0-90 days after the HF/CM diagnosis. Among women with pharmacy claims, a cardiologist visit was significantly associated with higher use of ACE-inhibitors or ARBs (60% v 44%, p=.039), and beta-blockers specifically indicated for HF treatment (40% v 24%, p=.026), compared to women who did not have cardiologist visit. One-year survival after HF/CM was higher patients with cardiologist consultation compared with no cardiologist consultation (79% v 91%, p=.001).
Conclusions: The majority of women who developed HF/CM after breast cancer therapy were not treated by a cardiologist, and had lower quality of care with higher 1-year mortality. This represents an important area for collaboration between oncologists and cardiologists to improve the care and outcomes of patients with HF/CM as a complication of breast cancer therapy.
Author Disclosures: J. Chen: B. Research Grant; Significant; American Heart Association Grant-in-Aid. J. Long: None. C. Chen: None. S. Wang: None. R. Steingart: None. C.P. Gross: None.
This research has received full or partial funding support from the American Heart Association, National Center.
- © 2014 by American Heart Association, Inc.