TABLE 1.

Common Reasons for CO Referral Across the Continuum of Cancer Care

Before cancer therapy
High baseline cardiovascular risk (by history of risk factors or disease)	Established CV disease, especially history of HF and MI Diabetes mellitus Hypertension Hyperlipidemia Pre-existing chronic inflammatory condition(s) History of tobacco use Prior anthracycline therapy Prior radiation therapy with exposure of heart or vasculature Prior cardiovascular toxicity related to cancer therapy
High cancer therapy-related risk	HER2-targeted therapy, especially in patients with other CV risk factors or anthracycline exposure Anthracyclines, especially with expected cumulative lifetime dose ≥250 mg/m2 Radiation with exposure to heart or vascular structures, especially in patients with a history of MI Tyrosine kinase inhibitors that are anti-angiogenic in activity or are known to have important vascular effects (e.g., targeting VEGFR, BCR-ABL, EGFR, and PDGFR), especially in patients with high CV risk Ibrutinib (BTK inhibitor), especially in patients with other risk factors for atrial fibrillation Proteasome inhibitors, especially in combination with other therapies Immune checkpoint inhibitors ICI, CAR T-cell therapy, and other forms of immunotherapy, especially with pre-existing immune conditions ADT, especially in patients with high baseline CV risk Hematopoietic stem cell transplantation
During cancer therapy
Pre-existing compensated or decompensated CVD	Cardiomyopathy/heart failure Coronary artery disease, especially a history of MI Arrhythmias/conduction disturbances including QT prolongation Pulmonary hypertension
New CVD as a complication of cancer therapy	Cardiomyopathy, acute HF with preserved or reduced ejection fraction Myocarditis Hypertensive crisis Endothelial and vascular dysfunction (accelerated atherosclerosis) Pericardial disease Arrhythmias/conduction disturbances including QT prolongation Pulmonary hypertension Thrombosis and bleeding
After cancer therapy
Pre-existing CVD	Cardiomyopathy and HF Atherosclerotic cardiovascular disease Thromboembolic disease
Complications of cancer therapy	Any CV complications from cancer treatment (see preceding text) Prior history of ADT Prior history of immunotherapy with ICI or CAR T-cell therapy History of pericardial disease (e.g., pericarditis, pericardial effusion) or pericardiocentesis Radiation-induced CV disease: myocardial, pericardial, coronary, valvular, arrhythmias, autonomic dysfunction
High long-term CV risk of cancer therapy	History of high-dose anthracycline therapy (e.g., doxorubicin ≥250 mg/m2) Radiation to the heart, neck, vascular structures (≥30 Gy) Lower-dose anthracycline plus trastuzumab Young or old age at time of diagnosis/treatment

ADT = androgen deprivation therapy; BCR-ABL = breakpoint cluster region-Abelson murine leukemia; BTK = Bruton’s tyrosine kinase; CAR = chimeric antigen receptor; CO = cardio-oncology; CV = cardiovascular; CVD = cardiovascular disease; EGFR = endothelial growth factor receptor; HF = heart failure; ICI = immune checkpoint inhibitor; MI = myocardial infarction; PDGFR = platelet-derived growth factor receptor; VEGFR = vascular endothelial growth factor receptor.