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Challenges in Implementing Optimal Echocardiographic Screening in Cardio-Oncology
James P McDonald1, James P MacNamara1, Vlad G Zaha2,3,4
1Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8568, USA.
Current Treatment Options in Cardiovascular Medicine
|July 11, 2019
Summary
Screening patients for cardiotoxic chemotherapy requires advanced echocardiography, but faces challenges in cost and implementation. Novel approaches like AI-guided ultrasound may offer solutions for detecting cardiac dysfunction.
Area of Science:
- Cardio-oncology
- Cardiovascular imaging
- Medical technology
Background:
- Echocardiography is crucial for screening patients receiving cardiotoxic chemotherapy.
- Guidelines advocate for integrated cardiology-oncology care and optimal non-invasive imaging.
- Implementing advanced screening technologies presents significant cost and administrative burdens.
Purpose of the Study:
- To review current literature on the quality, cost, patient burden, and value of widespread screening for cardiotoxic chemotherapy.
- To explore challenges and potential solutions in implementing optimal cardiac screening in cardio-oncology.
Main Methods:
- Review of recent studies on echocardiographic screening in patients exposed to cardiotoxic agents.
- Analysis of data regarding screening uptake, cost-effectiveness, and patient-centered outcomes.
Main Results:
- 3D and speckle tracking echocardiography offer improved detection of subtle cardiac changes compared to 2D methods.
- Optimal screening uptake is reported between 30-40%, with limited data on system-wide costs and patient burden.
- Novel approaches, including AI-guided point-of-care ultrasound, show promise in addressing implementation challenges.
Conclusions:
- Screening for cardiotoxicity from cancer therapeutics presents real-world healthcare system challenges.
- While advanced echocardiography enhances detection, further research is needed to understand and overcome widespread implementation barriers.
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