Journal of Clinical Cardiology

5-fluorouracil (5-FU), an antimetabolite in the fluoropyrimidine class, is the third most commonly used chemotherapeutic agent worldwide for the treatment of solid malignancies [1]. Despite advances in novel cancer therapies, commonly used in combination with fluoropyrimidines, 5-FU remains one of the most effective and safe chemotherapy agents to manage colorectal cancer (CRC).

Advances in oncology such as better access to health care system, earlier cancer diagnosis and new chemotherapies have led to longer survival of oncologic patients over the last decades. However, this population is vulnerable to cardiovascular drug-related adverse events like cardiomyopathy, which leads to heart failure and impairs survival and quality of life.

Immune checkpoint inhibitors (ICIs) are a new type of broad-spectrum antitumor drugs, which mainly include cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) inhibitors, programmed cell death protein-1 (PD-1) and its ligand PD-L1 inhibitors. Since 2011, ICIs have been approved for more than 20 kinds of malignant tumors.

Severe cardiotoxic side-effects are found in patients who are treated with anti-cancer drugs from both earliest chemotherapeutics (for example anthracyclines, such as Doxorubicin) and novel therapeutic compounds, such as monoclonal antibodies and small molecules inhibiting tyrosine kinases; e.g. crizotinib.

This is a high-value care-based quality improvement project that was carried out to decrease inappropriate troponin testing in the emergency department (ED) of a tertiary health institution in the United States with the goal of promoting evidence-based practices, minimizing waste, and enhancing the quality of care.