MDCalc

HFA-ICOS Baseline Cardio-Oncology Risk Assessment for HER2-Targeted Therapies

Stratifies cardiotoxicity risk in cancer patients scheduled to receive HER2-targeted therapies.

This tool is specifically for evaluating cardiotoxicity risk of HER2-targeted therapies.

Other HFA-ICOS cardiotoxicity risk assessments are available for the following therapies:

Previous Cardiovascular Disease

Heart failure or cardiomyopathy

Severe valvular heart disease

Myocardial infarction or CABG

Stable angina

Baseline LVEF

Arrhythmia

See Evidence for more details.

Cardiac Biomarkers

Elevated baseline troponin

See Evidence for more details.

Elevated baseline BNP or NT-proBNP

See Evidence for more details.

Demographic and Cardiovascular Risk Factors

Age, years

Hypertension

See Evidence for more details.

Diabetes mellitus

See Evidence for more details.

Chronic kidney disease

See Evidence for more details.

Current Cancer Treatment Regimen

Includes anthracycline before HER2-targeted therapy

Previous Cardiotoxic Cancer Treatment

Prior trastuzumab cardiotoxicity

Prior (remote) anthracycline exposure

See Evidence for more details.

Prior radiotherapy to left chest or mediastinum

Lifestyle Risk Factors

Current smoker or significant smoking history

Obesity (BMI >30 kg/m2)

Result:

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Advice

This tool is a decision-support aid and should be used alongside clinician judgment, patient preferences, specialist expertise, and current evidence-based guidelines/local protocols; results should not be the sole determinant of care.

Management
  • Low risk: Continue treatment with appropriate cardiovascular surveillance.
  • Medium risk: 
    • Provide closer monitoring of cardiovascular health. 
    • Manage cardiovascular risk factors.
    • Consider cardio-oncology or cardiology referral.
  • High and very high risk: 
    • Discuss risks and benefits of proposed chemotherapy.
    • Initiate closer cardiac monitoring.
    • Refer for cardio-oncology or cardiology assessment to optimise risk factors and provide a personalised management plan.
  • For more detailed guidance, please refer to the 2022 ESC guidelines.
Critical Actions

A referral to cardiology should be obtained for any patient who develops cardiotoxicity during therapy, regardless of initial risk.