Provider- and Hospital-Level Variation in Cardiac Monitoring Among Older Adults Receiving Cardiotoxic Cancer Therapy.

Area of Science:

• Oncology
• Cardiology
• Health Services Research

Background:

• Cardiac surveillance is recommended for cancer patients receiving cardiotoxic therapies but remains underutilized.
• Understanding provider- and hospital-level influences on monitoring adherence is crucial for improving care.

Purpose of the Study:

• To investigate the association between hospital-level factors and cardiac screening/monitoring in older cancer patients receiving cardiotoxic treatments.
• To identify factors contributing to suboptimal cardiac surveillance rates.

Main Methods:

• Utilized Surveillance, Epidemiology, and End Results-Medicare data linked with hospital data (2014-2018).
• Included patients aged 66+ receiving anthracyclines, anti-HER2 agents, or immune checkpoint inhibitors (ICIs).
• Assessed cardiac screening pre-treatment and monitoring post-treatment.

Main Results:

• Baseline cardiac screening rates were 54% (anti-HER2), 58% (anthracyclines), and 11% (ICIs).
• Provider factors explained 12% of screening variation; hospital factors explained 3%.
• Fewer than 1% received routine post-treatment monitoring.

Conclusions:

• Provider-level factors significantly impact cardiac surveillance gaps more than hospital-level factors.
• Interventions focused on clinician decision-making are needed to enhance guideline adherence for cardiac monitoring.