Background: The development of cardio-oncology units responds to the necessity of managing cardiovascular adverse events in patients with neoplasia, a patient population that proves an increasing survival trend due to the advanced oncological treatment strategies. However, the characterization of the adverse cardiovascular disease spectrum and recommendation for clinical practice is still not standardized. Since 2017, we established one of the first cardio-oncology units in Germany. University Hospital Essen provides a good structure for multidisciplinary cooperation between West German Heart and Vascular Center and West German Cancer Center. Additionally, integration within clinical research programs facilitates scientific progress.

Purpose:
The aim of this study was to evaluate clinical features, diagnostic and therapeutic management and outcomes of cancer patients with cardiovascular disease under the development of cardio-oncological patient care from a single-center experience.

Methods/Results:
A retrospective data analysis of patients, treated in the cardio-oncology unit of the West German Heart and Vascular Center, University Hospital Essen, Germany between July 2018 and September 2020 was performed and included in our “Essen Cardio-oncology Registry” (ECoR). In total, 748 patients (62 ± 15 years, 49 % male) and over 1500 clinical presentations were analyzed. Fast development and medical need for cardio-oncological patient care is expressed by increasing numbers of clinical consultation; starting with 20 consultations per month and reaching over 100 consultations in September 2020. Cutaneous melanoma (25.3%) and mamma carcinoma (24.9%) were the most common tumor entities presented in our cardio-oncology unit. Referral reasons were high baseline cardiovascular risk before chemotherapy, radiation therapy or cancer surgery as well as occurred adverse events during therapy (e.g. cardio-pulmonary symptoms, ejection fraction drop, troponin/ brain natriuretic peptide rise, arrhythmias, pericarditis, hypertension, thrombosis or pulmonary embolism). Exertional dyspnea was the leading symptom classified as NYHA II in 38.1% and NYHA III in 20.1% of all patients. Reduced ejection fraction (<50%) was observed in 22.8% of patients. Further diagnostic was indicated for cardiac catheter examination in 15.7%, transesophageal echocardiography in 6.9% and cardiac MRI in 5.4%. Additionally, catheter-interventional therapy of valvular heart diseases was performed in 4.6% of all included cancer patients. The identification and adjustment of cardiovascular risk factors was demonstrated to be highly important due to correlation with clinical symptoms, impaired cardiac function and outcome. Furthermore, mortality within 3 month after presentation was higher in patients with elevated troponin or BNP levels. Consisted with this results, initiation of heart failure medication and optimization of cardiovascular primary prevention was the main therapeutic action within cardio-oncological consultation (34.1%). Interruption of cancer treatment was recommended in 10%.

Conclusion: Treatment of cardio-oncological patients is still mainly base on expert opinions. Our study summarizes important patient characteristics and helps us to define standard operation procedures to further enhance outcome of cancer patients with cardiovascular comorbidity.