Electronic Health Records-Based Cardio-Oncology Registry for Care Gap Identification and Pragmatic Research: Procedure and Observational Study.
Electronic Health Records-Based Cardio-Oncology Registry for Care Gap Identification and Pragmatic Research: Procedure and Observational Study.
复制标题
作者：
Chandra A;Philips ST;Pandey A;Basit M;Kannan V;Sara EJ;Das SR;Lee SJC;Haley B;Willett DL;Zaha VG
专业协会正在制定癌症患者心血管护理指南。然而，目前尚不清楚在当代临床实践中如何有效地筛查和治疗癌症幸存者人群的心肌病。随着电子健康记录（EHRs）在临床实践中的广泛应用，我们验证了基于电子健康记录的心脏肿瘤学登记处可以解决这些问题的假设。本研究的目的是建立一个基于电子病历的实用心脏肿瘤学登记处，并作为原则证明，调查癌症患者心血管护理的护理差距。我们从我们的机构癌症人口登记处（N=8275, 2011-2017）的所有患者中生成了一个程序化识别的、基于实时电子病历的心脏肿瘤学登记处。我们研究了：(1)潜在心脏毒性药物治疗前后左心室射血分数（LVEF）评估；（2)针对左心室功能障碍（LVD）（定义为LVEF<50%）和LVEF降低的症状性心力衰竭（HFrEF）（定义为LVEF<50%）和收缩期充血性心力衰竭或扩张型心肌病的问题清单文件）的指南导向药物治疗（GDMT）。基于电子病历的心脏肿瘤学登记处的快速发展是可行的。使用基于ehr的心脏肿瘤学注册表和手工图表抽象来确定测试和结果是相似的（LVD的100%灵敏度和83%特异性）。19.8%的患者在癌症治疗开始前记录了LVEF。化疗后LVD和HFrEF的患病率相对较低（分别为9.4%和2.5%）。在化疗后LVD或HFrEF患者中，心脏病学患者的GDMT处方率明显更高。电子病历数据可以有效地填充实时、实用的心脏肿瘤学登记处，作为医疗保健交付调查的临床护理的副产品。
Professional society guidelines are emerging for cardiovascular care in cancer patients. However, it is not yet clear how effectively the cancer survivor population is screened and treated for cardiomyopathy in contemporary clinical practice. As electronic health records (EHRs) are now widely used in clinical practice, we tested the hypothesis that an EHR-based cardio-oncology registry can address these questions. The aim of this study was to develop an EHR-based pragmatic cardio-oncology registry and, as proof of principle, to investigate care gaps in the cardiovascular care of cancer patients. We generated a programmatically deidentified, real-time EHR-based cardio-oncology registry from all patients in our institutional Cancer Population Registry (N=8275, 2011-2017). We investigated: (1) left ventricular ejection fraction (LVEF) assessment before and after treatment with potentially cardiotoxic agents; and (2) guideline-directed medical therapy (GDMT) for left ventricular dysfunction (LVD), defined as LVEF<50%, and symptomatic heart failure with reduced LVEF (HFrEF), defined as LVEF<50% and Problem List documentation of systolic congestive heart failure or dilated cardiomyopathy. Rapid development of an EHR-based cardio-oncology registry was feasible. Identification of tests and outcomes was similar using the EHR-based cardio-oncology registry and manual chart abstraction (100% sensitivity and 83% specificity for LVD). LVEF was documented prior to initiation of cancer therapy in 19.8% of patients. Prevalence of postchemotherapy LVD and HFrEF was relatively low (9.4% and 2.5%, respectively). Among patients with postchemotherapy LVD or HFrEF, those referred to cardiology had a significantly higher prescription rate of a GDMT. EHR data can efficiently populate a real-time, pragmatic cardio-oncology registry as a byproduct of clinical care for health care delivery investigations.