Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Department of Pediatrics, Duke University Medical Center, Durham, NC.
JCO Clin Cancer Inform. 2021 Oct;5:1062-1075. doi: 10.1200/CCI.21.00099.
Cardiovascular disease is a significant cause of late morbidity and mortality in survivors of childhood cancer. Clinical informatics tools could enhance provider adherence to echocardiogram guidelines for early detection of late-onset cardiomyopathy.
Cancer registry data were linked to electronic health record data. Structured query language facilitated the construction of anthracycline-exposed cohorts at a single institution. Primary outcomes included the data quality from automatic anthracycline extraction, sensitivity of International Classification of Disease coding for heart failure, and adherence to echocardiogram guideline recommendations.
The final analytic cohort included 385 pediatric oncology patients diagnosed between July 1, 2013, and December 31, 2018, among whom 194 were classified as no anthracycline exposure, 143 had low anthracycline exposure (< 250 mg/m), and 48 had high anthracycline exposure (≥ 250 mg/m). Manual review of anthracycline exposure was highly concordant (95%) with the automatic extraction. Among the unexposed group, 15% had an anthracycline administered at an outside institution not captured by standard query language coding. Manual review of echocardiogram parameters and clinic notes yielded a sensitivity of 75%, specificity of 98%, and positive predictive value of 68% for International Classification of Disease coding of heart failure. For patients with anthracycline exposure, 78.5% (n = 62) were adherent to guideline recommendations for echocardiogram surveillance. There were significant association with provider adherence and race and ethnicity ( = .047), and 50% of patients with Spanish as their primary language were adherent compared with 90% of patients with English as their primary language ( = .003).
Extraction of treatment exposures from the electronic health record through clinical informatics and integration with cancer registry data represents a feasible approach to assess cardiovascular disease outcomes and adherence to guideline recommendations for survivors.
心血管疾病是儿童癌症幸存者晚期发病和死亡的重要原因。临床信息学工具可以增强提供者对超声心动图指南的依从性，以早期发现迟发性心肌病。
癌症登记数据与电子健康记录数据相关联。通过使用结构化查询语言，在单个机构构建蒽环类药物暴露队列。主要结局包括自动提取蒽环类药物的数据质量、国际疾病分类编码心力衰竭的敏感性以及对超声心动图指南建议的依从性。
最终分析队列包括 2013 年 7 月 1 日至 2018 年 12 月 31 日期间诊断的 385 名儿科肿瘤患者，其中 194 名患者无蒽环类药物暴露，143 名患者低剂量蒽环类药物暴露（<250mg/m），48 名患者高剂量蒽环类药物暴露（≥250mg/m）。自动提取的蒽环类药物暴露与手动审查高度一致（95%）。在未暴露组中，15%的患者在外部机构接受了未被标准查询语言编码捕获的蒽环类药物治疗。对超声心动图参数和临床记录进行手动审查，国际疾病分类编码心力衰竭的敏感性为 75%，特异性为 98%，阳性预测值为 68%。在有蒽环类药物暴露的患者中，78.5%（n=62）符合超声心动图监测指南建议。种族和民族与提供者的依从性存在显著关联（=0.047），说西班牙语的患者中有 50%符合指南建议，而说英语的患者中有 90%符合指南建议（=0.003）。
通过临床信息学从电子健康记录中提取治疗暴露情况，并与癌症登记数据集成，是一种评估心血管疾病结局和幸存者遵循指南建议的可行方法。
