Racial, Ethnic Differences in Cardiac Surveillance Following Anthracycline Therapy

Non-Hispanic Black and Hispanic patients receive less cardiac surveillance following anthracycline therapy for cancer, according to a study in the Journal of the American Heart Association.

The retrospective cohort study assessed cardiac surveillance per established guideline recommendations in a real-world clinical setting with use of electronic health records data from the OneFlorida Clinical Research Consortium.

Researchers identified patients diagnosed with cancer who received treatment from January 1, 2012, until April 30, 2020. Eligible patients were prescribed 2 or more doses of an anthracycline, including doxorubicin, daunorubicin, epirubicin, idarubicin, and mitoxantrone.

The primary objective was to evaluate associations between racial and ethnic groups in cardiac surveillance among cancer survivors after exposure to anthracyclines.

The cohort included 5430 patients and their median age was 53 years (63% women). Among the participants, 47% were non-Hispanic White, 31% were Hispanic, 17% were non-Hispanic Black, and 5% were classified as other. The most common cancer diagnoses associated with anthracycline therapy included lymphoma (35.6%), breast cancer (30.5%), and sarcoma (25.4%).

Of these patients, 63% received baseline imaging with echocardiography. Non-Hispanic Black patients were significantly less likely to have received a cardiac imaging assessment at baseline (odds ratio [OR], 0.75; 95% CI, 0.63-0.88; P =.0006) compared with non-Hispanic White patients. No significant differences were found for Hispanic or Non-Hispanic Black patients vs non-Hispanic White patients at 6 months and 12 months.

B-type natriuretic peptide (BNP) and N-terminal (NT)-proBNP assessment at baseline occurred in 6% of the patients with cancer, 7.7% in non-Hispanic White patients, 6.5% in non-Hispanic Black patients, 3.6% in Hispanic patients, and 4.3% patients classified as other. Hispanic patients had significantly reduced rates of BNP and NT-proBNP assessments at baseline, 6 months, and 12 months.

Regarding any cardiac surveillance (echocardiogram, BNP/NT-proBNP), non-Hispanic Black patients had a lower rate of baseline assessment than non-Hispanic White patients (63.3% vs 60%) with an adjusted OR of 0.76 (95% CI, 0.64-0.89; P =.001). No differences were observed in these 2 groups at 6 and 12 months. Hispanic patients had a lower rate of cardiac surveillance at 6 and 12 months compared with non-Hispanic White patients.

In adjusted ORs for age, sex, year of chemotherapy, diabetes, obesity, hypertension, and hyperlipidemia, compared with non-Hispanic White patients, Hispanic patients had a significantly lower rate of cardiac surveillance at 6 months (OR, 0.84; 95% CI, 0.72-0.98; P =.025) and 12 months (OR, 0.85; 95% CI, 0.74-0.98; P =.027).

Study limitations include lack of analysis for anthracycline dosing or radiation intensity. Other limitations include missing laboratory data, so it is not possible to assess changes in biomarkers for cardiotoxicities such as BNP, NT-pro BNP, or cardiac troponin for each racial or ethnic group.

“Recognition and clinical evaluation of heart failure risk factors such as hypertension, diabetes, and obesity should occur before anthracycline initiation,” wrote the investigators. “Clinicians need to be cognizant of social inequities and initiate efforts to ensure recommended cardiac assessment and active surveillance occurs in patients receiving anthracyclines.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.