Cardio-oncology in german inpatient care: current practice, interdisciplinary challenges and gaps in guideline implementation

Background Various chemotherapeutic agents can cause cardiotoxicity as adverse effect. This represents a relevant challenge in oncology care. Guideline-concordant prevention, diagnostics and longitudinal surveillance require clearly defined, interdisciplinary workflows across gynecology, oncology, cardiology and internal medicine. Purpose This study aimed to characterize the clinical management of cardio-oncology patients in inpatient gynecology, oncology, cardiology and internal medicine departments in Germany, to identify potential communication problems and gaps in care and to derive opportunities for improvement. Methods A questionnaire-based cross-sectional study was conducted. Current care structures, diagnostic standards and the perspectives of inpatient gynecologists, oncologists, cardiologists and internists regarding the management of patients receiving potentially cardiotoxic chemotherapy were assessed. In total, 27 gynecology, 28 oncology, 21 internal medicine and 44 cardiology departments participated, predominantly academic teaching hospitals (45.0%) and university hospitals (28.3%). Results Participating hospitals managed monthly a mean of 34 patients with cardio-oncological chemotherapy management. An overview of the treatment steps in which cardiology and/or internal medicine departments are involved is shown in Figure 1. Overall, involvement was reported mainly for cardiac diagnostics (83.5%), whereas structured risk stratification was included in 38.1% of cases. Standard diagnostic procedures primarily comprised echocardiography (89.5%) and ECG (82.1%). Cardiac biomarkers were obtained less frequently (troponin 30.5%; NT-proBNP 50.5%). High-risk patients were most commonly referred before initiation of chemotherapy (70.2%) and in the presence of acute symptoms (54.3%), but substantially less often during therapy (31.9% after every second cycle). A cardio-oncology board was held in only one participating hospital (1.2%). However, 27.5% of respondents considered a board useful for all cardio-oncology patients and 58.8% at least for high-risk cardio-oncology patients. The most frequently proposed measures to improve care were regular interdisciplinary education sessions (66.3%) and digital tools for risk stratification (62.8%) (Figure 2). Conclusions To the best of our knowledge, this is the first study investigating inpatient cardio-oncology care structures and interdisciplinary communication in Germany. The findings indicate a relevant discrepancy between current clinical practice and guideline-oriented recommendations, particularly regarding structured risk stratification and defined surveillance intervals. This suggests potential gaps in care with a risk of unrecognized cardiovascular complications. Structured communication formats (e.g. cardio-oncology boards), regular interdisciplinary training and tools for risk stratification were identified as key levers to improve cardio-oncology care.Figure 1Figure 2