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Cardiovascular Care in Multiple Myeloma: A Comprehensive Review and Integrated Systems-Based Approach from a UK
Daniel Akrawi1,2,3, Shayan Datta1, Suzan Hatipoglu1,4
1Cardio-Oncology Service, University College London Hospital, University College London Hospitals NHS Foundation Trust, London, UK.
Insights
Managing cardiovascular risks in multiple myeloma is crucial. Integrated cardio-oncology services improve patient outcomes by monitoring and managing treatment-related heart issues throughout the patient journey.
Area of Science:
- Cardio-oncology
- Hematology
- Cardiovascular Medicine
Background:
- Multiple myeloma (MM) patients face significant cardiovascular risks.
- These risks stem from disease factors like cardiac amyloidosis and treatment cardiotoxicity.
Purpose of the Study:
- To review cardiovascular complications in multiple myeloma and its therapies.
- To emphasize integrated cardiovascular management and the University College London Hospital Cardio-Oncology Centre model.
Main Methods:
- Longitudinal risk stratification before, during, and after anti-myeloma therapy.
- Multidimensional assessment including patient, disease, and treatment factors.
- Active surveillance with clinical assessment, biomarkers, and imaging.
Main Results:
- Cardiovascular vulnerability is multifactorial in MM.
- Integrated cardio-oncology services improve management and outcomes.
- Early referral and intervention are key for high-risk patients.
Conclusions:
- Integrated cardio-oncology services are vital for preserving cardiovascular health in MM patients.
- A systems-based approach ensures timely intervention and survivorship care.
- Multidisciplinary collaboration enhances patient management and access to effective therapies.
Purpose Of Review:
This review examines cardiovascular complications of multiple myeloma and anti-myeloma therapy, emphasising integrated systems-based cardiovascular management and the institutional model developed at the University College London Hospital Cardio-Oncology (CO) Centre of Excellence.
Recent Findings:
Cardiovascular vulnerability in multiple myeloma reflects baseline risk, disease-related factors, including cardiac amyloidosis, and treatment-related cardiotoxicity. A longitudinal approach should begin before therapy with multidimensional risk stratification incorporating patient, disease, and treatment factors, with intermediate- and high-risk patients referred for CO review. During treatment, active surveillance using clinical assessment, cardiac biomarkers and imaging, with vigilance for cardiac amyloidosis, enables rapid CO referral and timely intervention. Survivorship care should include annual cardiovascular review, risk-factor optimisation, and monitoring for late toxicity. Existing evidence and real-world experience support integrated CO services combining rapid-access clinics, high-volume cardiac imaging, timely decision-making, inpatient consultation, multidisciplinary collaboration, and survivorship surveillance while preserving cardiovascular health and access to effective anti-myeloma therapy.
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