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

Despite guideline recommendations, cardiac surveillance rates remain suboptimal for cancer patients exposed to potentially cardiotoxic treatments. The role of provider- and hospital-level factors in explaining suboptimal monitoring rates is understudied, while this information is necessary for a contextualized understanding. We quantified the relationship between hospital-level factors and cardiac screening and monitoring following the initiation of potentially cardiotoxic treatments. This study used Surveillance, Epidemiology, and End Results-Medicare patient-level data linked with hospital-level data. We included patients aged 66+ years who received potentially cardiotoxic treatments, including anthracycline, anti-human epidermal growth factor receptor 2 agents, and immune checkpoint inhibitors, between January 1, 2014 and December 31, 2018. The study outcome included the following: (1) receipt of cardiac screening within 30 days prior to or on the date of treatment initiation, and (2) routine cardiac monitoring within 1 year after treatment. A total of 2,143 patients were identified. Among those treated with anti-human epidermal growth factor receptor 2 therapy, anthracyclines, and immune checkpoint inhibitors, the proportions receiving cardiac screening at baseline were 54%, 58%, and 11%, respectively. Provider-level factors and hospital-level factors accounted for 12% and 3% of the variation in cardiac screening at baseline, respectively. Less than 1% of patients received routine monitoring following the initiation of potentially cardiotoxic treatments. In conclusion, these findings suggested that provider-level factors played a larger role in cardiac surveillance gaps than hospital-level factors. Interventions targeting clinician decision-making may be necessary to improve adherence to guideline-recommended cardiac monitoring.