A structured clinical decision support tool for cardiovascular risk stratification and longitudinal monitoring during anthracycline and HER2-targeted therapy
Y Kulmukhanov, Z H Tlegenova, A Amanova, S Balmagambetova, G Kurmanalina, I Talipova, G Sultanbekova, M Baspayeva, S Madinova, K Kubenova, G Ibraimova, B ZholdinAbstract
Background
Translating the 2022 ESC cardio-oncology recommendations into a structured clinical decision support tool may facilitate standardized cardiovascular assessment and risk-adapted monitoring in patients receiving potentially cardiotoxic cancer therapy.
Purpose
To develop and present a structured clinical decision support tool implementing ESC recommendations to assist clinicians in baseline cardiovascular (CV) risk stratification and stepwise monitoring during and after anthracycline and HER2-targeted therapy, including post-treatment risk reassessment.
Methods
The tool was developed in accordance with the 2022 ESC Cardio-Oncology Guidelines and the HFA-ICOS framework for baseline CV risk stratification, categorizing patients as low, moderate, high, or very high risk. The algorithm integrates routinely available clinical and treatment-related inputs, including patient characteristics, cardiovascular history, comorbidities, ECHO parameters, cardiac biomarkers, and cancer therapy-related factors. For anthracycline-treated patients, cumulative doxorubicin-equivalent dose is incorporated, with a threshold of ≥250 mg/m² triggering intensified monitoring. The application is based on a rule-driven, guideline-based algorithm that processes user-entered data and generates risk-adapted monitoring recommendations in real time. The tool provides therapy-specific, stepwise monitoring schedules before, during, and after cancer treatment and defines guideline-recommended clinical, imaging, and biomarker thresholds prompting escalation.
Results
The developed clinical decision support tool enables rapid and standardized baseline CV risk stratification (Figure 1) and automatically generates individualized, therapy-specific monitoring strategies across the entire treatment trajectory (Figure 2). For each patient, the tool transparently reports the rationale underlying risk category assignment and delivers actionable recommendations regarding the timing and frequency of ECG, echocardiography, and cardiac biomarker assessment. Predefined, guideline-based triggers for both asymptomatic and symptomatic cancer therapy-related cardiac dysfunction activate escalation pathways, including intensified monitoring, initiation of cardioprotective therapy, and multidisciplinary reassessment of oncological treatment. This structured approach supports consistent, reproducible clinical decision-making within routine cardio-oncology practice at the point of care.
Conclusion
This clinical decision support tool operationalizes ESC cardio-oncology recommendations into a reproducible and intuitive format suitable for everyday clinical practice. Standardization of baseline CV risk assessment and longitudinal monitoring may reduce inter-physician variability and facilitate earlier detection of subclinical myocardial dysfunction without introducing additional risk factors beyond current guideline recommendations.Figure 1 Figure 2