Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy University of Florida Gainesville FL USA.
University of Florida Health Cancer Center Gainesville FL USA.
J Am Heart Assoc. 2023 May 16;12(10):e027981. doi: 10.1161/JAHA.122.027981. Epub 2023 May 9.
Background Anthracyclines remain a key treatment for many malignancies but can increase the risk of heart failure or cardiomyopathy. Specific guidelines recommend echocardiography and serum cardiac biomarkers such as BNP (B-type natriuretic peptide) or NT-proBNP (N-terminal proBNP) evaluation before and 6 to 12 months after treatment. Our objective was to evaluate associations between racial and ethnic groups in cardiac surveillance of survivors of cancer after exposure to anthracyclines. Methods and Results Adult patients in the OneFlorida Consortium without prior cardiovascular disease who received at least 2 cycles of anthracyclines were included in the analysis. Multivariable logistic regression was performed to estimate the odds ratios (ORs) and 95% CIs for receiving cardiac surveillance at baseline before anthracycline therapy, 6 months after, and 12 months after anthracycline exposure among different racial and ethnic groups. Among the entire cohort of 5430 patients, 63.4% had a baseline echocardiogram, with 22.3% receiving an echocardiogram at 6 months and 25% at 12 months. Non-Hispanic Black (NHB) patients had a lower likelihood of receiving a baseline echocardiogram than Non-Hispanic White (NHW) patients (OR, 0.75 [95% CI, 0.63-0.88]; =0.0006) or any baseline cardiac surveillance (OR, 0.76 [95% CI, 0.64-0.89]; =0.001). Compared with NHW patients, Hispanic patients received significantly less cardiac surveillance at the 6-month (OR, 0.84 [95% CI, 0.72-0.98]; =0.03) and 12-month (OR, 0.85 [95% CI, 0.74-0.98]; =0.03) time points, respectively. Conclusions There were significant racial and ethnic differences in cardiac surveillance among survivors of cancer at baseline and following anthracycline-based treatment in NHB and Hispanic cohorts. Health care providers need to be cognizant of these social inequities and initiate efforts to ensure recommended cardiac surveillance occurs following anthracyclines.
背景 蒽环类药物仍然是许多恶性肿瘤的重要治疗方法，但会增加心力衰竭或心肌病的风险。具体指南建议在治疗前和治疗后 6 至 12 个月进行超声心动图和血清心脏标志物（如 BNP（B 型利钠肽）或 NT-proBNP（N 端 proBNP））评估。我们的目的是评估在接受蒽环类药物治疗后癌症幸存者的心脏监测中，不同种族和族裔群体之间的关联。 方法和结果 在 OneFlorida 联盟中，纳入没有先前心血管疾病且接受至少 2 个周期蒽环类药物治疗的成年患者进行分析。多变量逻辑回归用于估计不同种族和族裔群体在蒽环类药物治疗前、治疗后 6 个月和 12 个月时接受心脏监测的比值比（OR）和 95%CI。在整个 5430 例患者队列中，63.4%的患者在基线时有超声心动图，22.3%的患者在 6 个月时和 25%的患者在 12 个月时接受超声心动图检查。与非西班牙裔白人（NHW）患者相比，非西班牙裔黑人（NHB）患者进行基线超声心动图检查的可能性较低（OR，0.75 [95%CI，0.63-0.88]；=0.0006）或任何基线心脏监测（OR，0.76 [95%CI，0.64-0.89]；=0.001）。与 NHW 患者相比，西班牙裔患者在 6 个月（OR，0.84 [95%CI，0.72-0.98]；=0.03）和 12 个月（OR，0.85 [95%CI，0.74-0.98]；=0.03）时接受的心脏监测明显较少。 结论 在 NHB 和西班牙裔队列中，癌症幸存者在基线时和接受基于蒽环类药物治疗后，心脏监测存在显著的种族和族裔差异。医疗保健提供者需要意识到这些社会不平等现象，并努力确保在使用蒽环类药物后进行推荐的心脏监测。
