基于电子健康记录的心脏肿瘤学登记系统用于识别照护差距和务实研究：程序与观察性研究

Electronic Health Records-Based Cardio-Oncology Registry for Care Gap Identification and Pragmatic Research: Procedure and Observational Study.

作者信息

Chandra Alvin, Philips Steven T, Pandey Ambarish, Basit Mujeeb, Kannan Vaishnavi, Sara Evan J, Das Sandeep R, Lee Simon J C, Haley Barbara, Willett DuWayne L, Zaha Vlad G

机构信息

Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States.

Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States.

出版信息

JMIR Cardio. 2021 May 12;5(1):e22296. doi: 10.2196/22296.

DOI:10.2196/22296

PMID:33797396

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8411429/

Abstract

BACKGROUND

Professional society guidelines are emerging for cardiovascular care in cancer patients. However, it is not yet clear how effectively the cancer survivor population is screened and treated for cardiomyopathy in contemporary clinical practice. As electronic health records (EHRs) are now widely used in clinical practice, we tested the hypothesis that an EHR-based cardio-oncology registry can address these questions.

OBJECTIVE

The aim of this study was to develop an EHR-based pragmatic cardio-oncology registry and, as proof of principle, to investigate care gaps in the cardiovascular care of cancer patients.

METHODS

We generated a programmatically deidentified, 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.

RESULTS

Rapid development of an EHR-based cardio-oncology registry was feasible. Identification of tests and outcomes was similar using the 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 postchemotherapy LVD and HFrEF was relatively low (9.4% and 2.5%, respectively). Among patients with postchemotherapy LVD or HFrEF, those referred to cardiology had a significantly higher prescription rate of a GDMT.

CONCLUSIONS

EHR data can efficiently populate a real-time, pragmatic cardio-oncology registry as a byproduct of clinical care for health care delivery investigations.

摘要

背景

针对癌症患者心血管护理的专业学会指南正在不断涌现。然而，在当代临床实践中，对于癌症幸存者群体中心肌病的筛查和治疗效果究竟如何，目前尚不清楚。由于电子健康记录（EHR）如今已在临床实践中广泛应用，我们检验了这样一个假设，即基于EHR的心脏肿瘤学登记系统能够解决这些问题。

目的

本研究的目的是开发一个基于EHR的实用心脏肿瘤学登记系统，并作为原则证明，调查癌症患者心血管护理中的差距。

方法

我们从机构癌症人群登记系统中的所有患者（N = 8275，2011 - 2017年）生成了一个经过程序去识别化的、基于EHR的实时心脏肿瘤学登记系统。我们调查了：（1）使用潜在心脏毒性药物治疗前后的左心室射血分数（LVEF）评估；以及（2）针对左心室功能障碍（LVD，定义为LVEF < 50%）和射血分数降低的症状性心力衰竭（HFrEF，定义为LVEF < 50%且问题列表中记录有收缩性充血性心力衰竭或扩张型心肌病）的指南指导药物治疗（GDMT）。

结果

快速开发基于EHR的心脏肿瘤学登记系统是可行的。使用基于EHR的心脏肿瘤学登记系统和手工图表摘要识别检查和结果的情况相似（LVD的敏感性为100%，特异性为83%）。19.8%的患者在开始癌症治疗前记录了LVEF。化疗后LVD和HFrEF的患病率相对较低（分别为9.4%和2.5%）。在化疗后出现LVD或HFrEF的患者中，转诊至心脏病科的患者接受GDMT的处方率显著更高。