ToolsCalculators
HFA-ICOS Baseline Cardio-Oncology Risk Assessment for HER2-Targeted Therapies
Baseline cardiotoxicity risk stratification before HER2-targeted therapy (e.g. trastuzumab).
HFA-ICOS Baseline Cardio-Oncology Risk Assessment for HER2-Targeted Therapies
Existing heart failure or cardiomyopathy
Prior trastuzumab-related cardiotoxicity
Prior myocardial infarction or coronary artery bypass grafting
Stable angina
Severe valvular heart disease
Baseline LVEF <50%
Age ≥80 years
Borderline LVEF 50-54%
Arrhythmia
Elevated baseline troponin
Elevated baseline BNP or NT-proBNP
Age 65-79 years
Prior (remote) anthracycline exposure
Prior radiotherapy to the left chest or mediastinum
Hypertension
Diabetes mellitus
Chronic kidney disease
Anthracycline given shortly before starting HER2-targeted therapy
Current smoker or significant smoking history
Obesity (BMI >30 kg/m²)
ResultLow risk
No or only a single medium-risk (1-point) factor is present. Routine baseline assessment is sufficient.
- Medium-risk points
- 0
- Overall risk category
- Low risk
When to use
- Baseline cardiovascular risk stratification before starting HER2-targeted therapy in patients with cancer.
- Determining how intensively to monitor cardiac function during treatment.
Formula
Overall risk = Very high if any very-high-risk criterion is present; otherwise High if any high-risk criterion is present OR medium-risk points total ≥5; otherwise Moderate if medium-risk points total 2-4; otherwise Low (0 or 1 medium-risk point). Medium-risk items are weighted 1 or 2 points as specified.
Pearls and pitfalls
- Any single very-high-risk criterion overrides the point total and classifies the patient as very high risk.
- Risk category is intended to guide referral to cardio-oncology and the frequency of on-treatment cardiac imaging/biomarker surveillance, not to withhold effective cancer therapy.