Utilization of Global Longitudinal Strain for Cardiotoxicity Surveillance in Cancer Patients Receiving Anthracyclines or Trastuzumab: Insights From the National Inpatient Sample
Abstract
Background Global longitudinal strain (GLS) echocardiography allows earlier detection of subclinical left ventricular dysfunction compared to ejection fraction (EF) alone and is recommended in guidelines for cardio-oncology surveillance. However, real-world adoption of GLS remains poorly understood, particularly across insurance groups. We examined utilization patterns of GLS echocardiography among cancer patients at risk for chemotherapy-induced cardiotoxicity. Methods We performed a retrospective cohort study using the National Inpatient Sample (2018–2023). Adult patients (≥18 years) with breast cancer, lymphoma, or sarcoma who received anthracyclines or trastuzumab were included. Utilization of GLS echocardiography during hospitalization or follow-up surveillance was identified using billing and procedure codes. Patients were stratified by insurance type (private, Medicare, Medicaid). Multivariable logistic regression was used to estimate adjusted odds of GLS use, controlling for demographics, comorbidities, cancer type, and hospital-level variables. Results Among 16,700 eligible patients, only 22% underwent GLS surveillance. Utilization was highest among privately insured patients (35%), compared with 18% for Medicare and 12% for Medicaid. After adjustment, Medicaid patients had 68% lower odds of receiving GLS (aOR 0.32, 95% CI 0.26–0.39) compared with privately insured patients, while Medicare patients had 55% lower odds (aOR 0.45, 95% CI 0.38–0.52). Despite guideline recommendations, EF-based monitoring remained the predominant strategy across all groups. Conclusion GLS echocardiography, a recommended modality for early detection of chemotherapy-induced cardiotoxicity, remains significantly underutilized in clinical practice. Profound disparities in utilization exist by insurance status, with Medicaid and Medicare patients being far less likely to receive GLS compared with privately insured patients. These findings highlight the gap between guidelines and practice and underscore the need for standardized, equitable cardio-oncology surveillance pathways.
Start Time
15-4-2026 1:30 PM
End Time
15-4-2026 4:30 PM
Room Number
Culp Ballroom 316
Poster Number
21
Presentation Type
Poster
Presentation Subtype
Posters - Competitive
Presentation Category
Science, Technology, and Engineering
Student Type
Graduate and Professional Degree Students, Residents, Fellows, and Other Registrants
Faculty Mentor
Manar Jbara
Utilization of Global Longitudinal Strain for Cardiotoxicity Surveillance in Cancer Patients Receiving Anthracyclines or Trastuzumab: Insights From the National Inpatient Sample
Culp Ballroom 316
Background Global longitudinal strain (GLS) echocardiography allows earlier detection of subclinical left ventricular dysfunction compared to ejection fraction (EF) alone and is recommended in guidelines for cardio-oncology surveillance. However, real-world adoption of GLS remains poorly understood, particularly across insurance groups. We examined utilization patterns of GLS echocardiography among cancer patients at risk for chemotherapy-induced cardiotoxicity. Methods We performed a retrospective cohort study using the National Inpatient Sample (2018–2023). Adult patients (≥18 years) with breast cancer, lymphoma, or sarcoma who received anthracyclines or trastuzumab were included. Utilization of GLS echocardiography during hospitalization or follow-up surveillance was identified using billing and procedure codes. Patients were stratified by insurance type (private, Medicare, Medicaid). Multivariable logistic regression was used to estimate adjusted odds of GLS use, controlling for demographics, comorbidities, cancer type, and hospital-level variables. Results Among 16,700 eligible patients, only 22% underwent GLS surveillance. Utilization was highest among privately insured patients (35%), compared with 18% for Medicare and 12% for Medicaid. After adjustment, Medicaid patients had 68% lower odds of receiving GLS (aOR 0.32, 95% CI 0.26–0.39) compared with privately insured patients, while Medicare patients had 55% lower odds (aOR 0.45, 95% CI 0.38–0.52). Despite guideline recommendations, EF-based monitoring remained the predominant strategy across all groups. Conclusion GLS echocardiography, a recommended modality for early detection of chemotherapy-induced cardiotoxicity, remains significantly underutilized in clinical practice. Profound disparities in utilization exist by insurance status, with Medicaid and Medicare patients being far less likely to receive GLS compared with privately insured patients. These findings highlight the gap between guidelines and practice and underscore the need for standardized, equitable cardio-oncology surveillance pathways.
