This is a prospective study in which a process of identifying and reducing heart failure (HF) risk will be applied to cancer survivors \>55 years old with chemotherapy \>5 years ago.
The overall goal of this study to identify the feasibility and value of risk-guided cardiac rehabilitation (exercise, risk factor modification, and behavioural support) as a component of survivorship care.
History of cancer > 10 years ago
Have received potentially toxic chemotherapy Anthracycline (any dose) Trastuzumab (Herceptin) in breast-cancer with the HER2 mutation OR Tyrosine kinase inhibitors (e.g. sunitinib) OR Left chest radiotherapy
Ejection fraction at baseline echo <50%
Valvular stenosis or regurgitation of >moderate severity
History of previous heart failure (baseline New York Heart Association (NYHA) classification >2)
Systolic BP <110 mmHg
Parallel
Heart Failure intervention (Cardio-Oncology Disease Management Plan (CO-DMP)
Other interventionA clinical review to ensure optimal risk factor control and cardioprotection along with exercise intervention.
Usual care
Other interventionprovided by participants' usual healthcare professional(s)
Change in exercise capacity
Cardio pulmonary fitness (peak oxygen uptake (VO2 peak)) from baseline to follow up.
Medication adherence
proportion of ACEi and beta blocker tablets taken
Neuromuscular strength
Maximal isometric grip strength (kg) assessed using a digital grip strength dynamometer
Endurance
Increase in total exercise duration.
Left ventricular function
Change in global longitudinal strain (GLS) using echocardiographic speckle-tracking
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