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Rutas asistenciales en cardio-oncología

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Ponencia realizada por la Dra. Teresa López-Fernández en el directo online 'Cáncer y riesgo cardiovascular: necesidad de equipos multidisciplinares', del ciclo COH19, celebrado en la Casa del Corazón el 7 de mayo de 2019

Published in: Health & Medicine
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Rutas asistenciales en cardio-oncología

  1. 1. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Rutas asistenciales en COH Teresa López-Fernández Hospital Universitario La Paz
  2. 2. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Objetivos 1 Cáncer y riesgo CV 3 Rutas Asistenciales 2 Equipos de COH
  3. 3. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 •  Toxicidad CV antitumorales •  2/3 con >65 años •  30% ECV previa •  Tratamiento a largo plazo Mayo Clin Proc. 2016;91(1):81-83JACC. 2018;71(19):2149–61;
  4. 4. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Toxicidad CV por antitumorales Lenneman & Sawyer. Circ Res 2016; 118:1008-20; Circulation. 2019;139:00–00. DOI: 10.1161/CIR.0000000000000679 Toxicidad tardía Dº precoz FRCV Toxicidad aguda
  5. 5. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Interrupción Tto. Breast Cancer Res Treat. 2014;146: 411–419; Exclusión de EC Unger JM et al JAMA Oncol 2019 Jan 10. doi: 10.1001/jamaoncol.2018.5953. Toxicidad aguda
  6. 6. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 J Clin Oncol. 2013 Oct 10;31(29):3673-80 Toxicidad CV tardía
  7. 7. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 European Heart Journal (2018) 0, 1–8 German CVSS-study
  8. 8. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 2. Equipos COH
  9. 9. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Equipos de Cardio-Onco-Hematología Farmakis D et al. Eur J Heart Failure (2018) doi:10.1002/ejhf.1336Lancellotti P. Suter T. López-Fernández T et al. Eur Heart Journal (2018) 00, 1–8;
  10. 10. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Equipos de Cardio-Onco-Hematología Farmakis D et al. Eur J Heart Failure (2018) doi:10.1002/ejhf.1336Lancellotti P. Suter T. López-Fernández T et al. Eur Heart Journal (2018) 00, 1–8;
  11. 11. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Farmakis D et al. Eur J Heart Failure (2018) doi:10.1002/ejhf.1336 Equipos de Cardio-Onco-Hematología López Fernández T et al. Medicine. 2017;12(43):2593-5;
  12. 12. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Equipos de Cardio-Onco-Hematología Estrategias de prevención 1.  Riesgo CTox! 2.  Optimizar RCV! 3.  Monitorización Farmakis D et al. Eur J Heart Failure (2018) doi:10.1002/ejhf.1336López Fernández T et al. Medicine. 2017;12(43):2593-5;
  13. 13. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 535 pacientes (ANT, anti-HER2, TKI) 93% mejora DSVI 88% continúan TOH Eur J Heart Failure (2018) doi:10.1002/ejhf.1292
  14. 14. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 3. Rutas asistenciales
  15. 15. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 https://secardiologia.es/institucional/reuniones- institucionales/sec-calidad/sec-primaria
  16. 16. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 https://secardiologia.es/institucional/reuniones-institucionales/sec-calidad/sec-primaria
  17. 17. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Prevención CTox = Evaluar riesgo basal López-Fernández T, et al. Rev Esp Cardiol 2017;70:474–86.
  18. 18. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Papel activo de la enfermería •  Salud CV •  Interacciones •  Polifarmacia •  Carnet https://secardiologia.es/institucional/reuniones-institucionales/sec-calidad/sec-primaria
  19. 19. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Prevención CTox = Prevención RCV López-Fernández T, et al. Rev Esp Cardiol 2017;70:474–86.
  20. 20. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 gestion@mimocardio.orgwww.mimocardio.org
  21. 21. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Circulation 2019;139:00–00. DOI: 10.1161/CIR.0000000000000679
  22. 22. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Criterios de derivación a cardiología https://secardiologia.es/institucional/reuniones-institucionales/sec-calidad/sec-primaria
  23. 23. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Contenidos de los informes https://secardiologia.es/institucional/reuniones-institucionales/sec-calidad/sec-primaria
  24. 24. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Contenidos de los informes https://secardiologia.es/institucional/reuniones-institucionales/sec-calidad/sec-primaria
  25. 25. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 • Pacientes con riesgo de ICC • Pacientes con riesgo de C- isquémica • Pacientes con riesgo de arritmias • Largos supervivientes Recomendaciones de monitorización https://secardiologia.es/institucional/reuniones-institucionales/sec-calidad/sec-primaria
  26. 26. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Retos • Definición de cardiotoxicidad • Score de riesgo prospectivo basado en las guías clínicas • Monitorización guiada por el riesgo de eventos
  27. 27. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Thavendiranathan P et al J Clin Oncol 2018 May 23:JCO2018779736 Retos
  28. 28. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Hayek, S.S. et al. J Am Coll Cardiol. 2019; 73 (17): 2226-35 Componentes de un programa de COH
  29. 29. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 1.  Continuidad asistencial! Rutas asistenciales en COH 2. Prevención CV = Prevención CTox! 3. Investigación- Formación- Información!
  30. 30. Rutas asistenciales en Cardio-Onco-Hematología Teresa López-Fernández @TeresaLpezFdez1 Muchas gracias @TeresaLpezFdez1 tlfernandez8@gmail.com

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