S. R. Pereboom1,2, A. Nijdam2, B. M. P. Aleman2, R. W. M. van der Maazen1, J. M. Zijlstra3, R. J. de Weijer4, M. B. van’t Veer5, J. M. M. Raemaekers6, F. E. van Leeuwen2, on behalf of the BETER consortium7
1 Radboud University Medical Center, Nijmegen, the Netherlands, 2 The Netherlands Cancer Institute, Amsterdam, the Netherlands, 3 Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands, 4 University Medical Center Utrecht, Utrecht, the Netherlands, 5 Leiden University Medical Center, Leiden, the Netherlands, 6 Rijnstate Hospital, Arnhem, the Netherlands, 7 Better care after Hodgkin lymphoma: Evaluation of long-term Treatment Effects and screening Recommendations
Introduction: Survivors of Hodgkin lymphoma (HL) are at increased risk of late adverse effects of treatment, such as cardiovascular disease (CVD), but until recently screening for CVD was not performed. The Dutch BETER consortium has established a national infrastructure of survivorship care outpatient clinics where ≥ 5 year HL survivors are recalled for surveillance and screened for late effects according to the newly developed BETER guidelines. This study evaluates adherence to the BETER cardiovascular screening guideline and the value of the BETER clinic in finding previously undiagnosed cardiovascular conditions.
Methods: Data on BETER clinic visits were collected on the first 131 HL survivors at the University Medical Centers of Utrecht and Amsterdam and the Netherlands Cancer Institute. Adherence to the cardiovascular screening guideline was assessed for medical history, physical examination, blood tests, ECG and echocardiography. Descriptive statistics were calculated to assess the characteristics of cardiovascular follow up at the BETER clinics.
Results: 123 out of 131 (94%) HL survivors were at risk of CVD based on HL treatment and eligible for cardiovascular screening (Table 1). 21% of patients at risk had already been diagnosed with CVD before the BETER clinic visit.
In all 123 survivors the BETER physician (assistant) actively enquired about the presence of cardiovascular risk factors and in 94% about the presence of cardiovascular symptoms. Physical examination to assess cardiovascular risk factors was performed in 76% of survivors. Echocardiography was performed in 98% and ECG in 94% of survivors, while blood tests were done in 86% of survivors. Full CVD guideline adherence was 63%.
Previously undiagnosed cardiovascular conditions were found in 15% of survivors; in 5% of survivors worsening of pre-existing cardiovascular conditions was diagnosed at the BETER clinic. Frequently observed conditions were valve sclerosis (n = 12), aortic valve stenosis (n = 8) and mitral valve insufficiency (n = 5). Heart failure and coronary artery disease were diagnosed less frequently (n = 1 each). 6% of survivors had a subclinical systolic ventricular dysfunction (EF<50%).
Conclusion: Preliminary results show good adherence to the cardiovascular screening guideline. Furthermore, the BETER screening had a substantial yield of actionable conditions. Evaluation is ongoing; at ISHL11 information on follow-up diagnostics and interventions in 250 patients will be presented.