Current practice and unmet needs in inpatient cardio-oncology in Germany
S Poley, L Harst, M Christoph, M Koesters, K Ibrahim, T Haase, J Hamann, L Payo, S QuickAbstract
Background
Cardiotoxic adverse effects of various chemotherapeutic agents represent a relevant challenge in oncology care. Guideline-concordant prevention, diagnostics and longitudinal surveillance require clearly defined, interdisciplinary workflows across oncology, cardiology and internal medicine.
Objective
This study aimed to characterize the clinical management of cardio-oncology patients in inpatient cardiology and internal medicine departments in Germany, to identify potential communication problems and gaps in care and to derive opportunities for improvement.
Methods
A questionnaire-based cross-sectional study was conducted. Current care structures, diagnostic standards and the perspectives of inpatient cardiologists and internists regarding the management of patients receiving potentially cardiotoxic chemotherapy were assessed. In total, 21 internal medicine and 44 cardiology departments participated, predominantly academic teaching hospitals (46.2%) and university hospitals (33.8%).
Results
Participating hospitals managed a mean of 11 cardio-oncology patients per month (maximum 100). An overview of the treatment steps in which cardiology and/or internal medicine departments are involved is shown in Figure 1. Overall, involvement was reported mainly for cardiac diagnostics (80.8%), whereas structured risk stratification was included in fewer than 50% of cases. Standard diagnostic procedures primarily comprised ECG (90.2%) and echocardiography (88.2%). Cardiac biomarkers were obtained less frequently (troponin 39.2%; NT-proBNP 68.6%). High-risk patients were most commonly referred before initiation of chemotherapy (62.0%), in the presence of acute symptoms (48.0%) and after completion of chemotherapy (44.0%), but substantially less often during therapy (16.0% after every second cycle). A cardio-oncology board was held in only one participating hospital (2.3%). Nevertheless, 39.5% of respondents considered a board useful for all cardio-oncology patients and 51.2% at least for high-risk cardio-oncology patients. The most frequently proposed measures to improve care were regular interdisciplinary education sessions (70.5%), digital tools for risk stratification (68.2%) and tools to improve the detection/assessment of cardiotoxicity (68.2%) (Figure 2).
Conclusion
To the best of our knowledge, this is the first study investigating inpatient cardio-oncology care structures and interdisciplinary communication in Germany. The findings indicate a relevant discrepancy between current clinical practice and guideline-oriented recommendations, particularly regarding structured risk stratification and defined surveillance intervals. This suggests potential gaps in care with a risk of unrecognized cardiovascular complications. Structured communication formats (e.g. cardio-oncology boards), regular interdisciplinary training and digital decision-support and monitoring tools were identified as key levers to improve cardio-oncology care.Figure 1 Figure 2