Quality indicators in cardio-oncology: a survey from the working group of cardiotoxicity and cardioprotection of the italian society of cardiology (SIC)

Abstract Background Recently, quality indicators (QIs) for the management of patients with cancer or cancer survivors have been identified in cardio-oncology and the first ESC Guidelines on cardio-oncology have been published in 2022. The management of cancer patients requires dedicated healthcare professionals, a multidisciplinary team which should consist of at least an oncologist, cardiologist and a specialist nurse. Purpose to investigate the adherence to QIs in Italian cardio-oncology clinic and the application in clinical practice of ESC Cardio-oncology Guidelines. Methods A cross-sectional survey was developed by members of the Working group of cardiotoxicity and cardioprotection of the Italian Society of Cardiology (SIC). The survey consisted of 19 questions which include demographic information, multiple-choice questions related to organization and quality of cardio-oncology laboratories. Results 77 answers were received from Italian hospitals (of whom 80% from university hospital). We found that dedicated cardio-oncology clinics were present in 70% of hospitals which answered. 75% of these hospitals had at least one physician dedicated to cardio-oncology. Clinical application of ESC Guidelines on cardio-oncology was performed in 83% of hospitals. Regarding the number of dedicated cardio-oncological visits performed weekly: 54% of centers performed between 0-12 visits, 30% between 13-24, 6% between 25-36, 11% performed 36 visits. Multi-disciplinary team was present in 65% of hospitals and it included only cardiologist and oncologist in 50% of cases; only 20% conformed the presence of a multi-disciplinary team with cardiologist, oncologist, radiologist, professional nurse, surgeon, palliative care. Baseline cardiovascular risk was assessed in 54% of participants; 65% of participants organized follow-up according to the ESC guidelines. The prevalent tumor referred to the cardio-oncology clinic was : breast cancer (45%), followed by gastro-intestinal (14%), hematological (23%), lung (17%). Regarding hospitalization for cardiovascular complication in 1 year were: 78% had between 0-10 hospitalizations, 17% between 11-22, 6% had 35 hospitalizations. Heart failure was the most frequent cardiovascular complication (59%). Only 72% of participants routinely performed assessment of global longitudinal strain; only 48% always assessed cardiac biomarkers. Cardio-protection has been started in patients at high and very high risk only in 53% of cardio-oncology clinic. Only 19% of participants thinks that current cardio-oncology clinics have criteria that meet the current ESC Cardio-oncology guidelines. Conclusion Data emerging from this survey outline that ESC cardio-oncology guidelines have been received by the Italian community however implementation in clinical practice still need to be improved and quality indicators are not fully achieved. Further efforts and resources are needed to meet necessary quality indicators in cardio-oncology