Ontology Selection for 5 Clinical Factors
· Ischemic
Heart Disease Evaluation - Ischemic heart disease is essentially a buildup
of plaque narrowing the heart arteries and can cause an multitude of issues for
the patients. There are multiple clinical factors to consider when evaluating
patients pre-treatment and post-treatment. In an evaluation of childhood cancer
survivors found that the likelihood of adult stage Ischemic Heart Disease
occurred at a higher rate due to early exposures to platinum agents, alkylator
and radiotherapy (Chow et al., 2018). Moreover, additional lifestyle habits and
genetic factors alos play a critical role in detecting ischemic heart disease
in patients preparing for radiotherapy. Some precursors to consider are age,
smoking status, systolic blood pressure, serum cholesterol, and family history
according to the Reynolds Risk Score (as cited in Taylor & Darby, 2014).
· Cardiovascular
Risk Assessment Before Radiation (Chest, Head/ Neck etc.) - Cardiovascular
Risk Assessment is a fundamental mechanism used to prevent the outcome of
cardiovascular disease (CVD). The primary underlying risk factors that helps to
identify patients who may suffer CVD in the future includes age, sex, high low
density lipoprotein (LDL) low
high-density lipoprotein (HDL), high blood pressure, diabetes mellitus, tobacco
usage, and family history. These are common factors for at risk patients.
Moreover, according to more comprehensive sets of data markers combined by
multiple groups. Additional factors have become evident which include gender,
ethnicity, and BMI (Petcher & Moran, 2017).
· Cardiovascular
Risk Assessment Before Stem Cell Transplant - Common risk factors are
similar to that previously mentioned which include age, sex, LDL & HDL
levels, family history and tobacco usage. However, in a study focused on
patients who underwent hematopoietic stem cell transplantation BMI and
nutritional status posed the highest risk for potential cardiovascular disease
post treatment (Morais et al., 2018). This risk factor is common across the
board to increase the risk of cardiovascular disease. Obesity is a concern in
raising the potential for an plethora of health concerns, but is more prevalent
in increased risk of cancers and heart disease.
· Congestive
Heart Failure/Cardiomyopathy Evaluation - Current clinical factors to
consider are determined by type of cancer therapy being provided. In patients
who are undergoing treatment of one of the following which include:
anthracyclines, trastuzumab, cyclophosphamide, taxanes, 5-fluorouracil and
interferons are at the highest risk for cardiotoxicity. With this being the
major cause of future cardiac problems these patients may undergo preliminary
tests such as echocardiogram pre-therapy and post-therapy to determine a
baseline and be subject to surveillance. The more common factor similar to
other referral sources are a family history, and current health conditions that
serve as the best predetermination in assessing the overall health risk of a
patient (Hamo et al., 2016).
· Cardiovascular
Risk Assessment before Chemotherapy, Targeted Therapy, Immunotherapy - For
the advancement of cardio-oncology in assessing patients pre-treatment a more
thorough assessment is required. This would include echocardiogram, certain
examination to test blood levels, family history review, and current lifestyle.
The general precursor to cardiac issues again is a general list of precursors
that are applied across the board including age, sex, family history, and
lifestyle habits (Hermann, 2014).
· Key
Clinical Factors as a Precursor to Identify High Risk Patients who may Benefit
from Cardio-Oncology Intervention Include:
o Weight
o Tobacco Usage
o Family History of Cardiac Problems
o Age… (40 and Older at higher risk)
o Diet
o Current Medical Conditions
o Treatment Options Specifically Radiation
therapy, anthracyclines, trastuzumab, cyclophosphamide, taxanes, 5-fluorouracil
and interferons.
2. Identifying Risk Factors
Referral
Sources
|
Ontology/Vocabulary
|
Code
|
Definitions
|
Ischemic
Heart Disease Evaluation
|
SNOMED-CT
|
· 414916001
· 238131007
· 365981007
· 297242006
· 308068007
|
· Obesity
(disorder)
· Overweight
(finding)
· Finding
of tobacco smoking behavior (finding)
· Family
history of ischemic heart disease (situation)
· History
of treatment for ischemic heart disease (situation)
|
Cardiovascular
Risk Assessment Before Radiation (Chest, Head/ Neck etc.)
|
SNOMED-CT
|
· 414916001
· 238131007
· 365981007
· 439724007
· 438825005
|
· Obesity
(disorder)
· Overweight
(finding)
· Finding
of tobacco smoking behavior (finding)
· Family
history of cardiovascular disease in first degree male relative less than 55
years of age (situation)
· Family
history of cardiovascular disease in first degree female relative less than
65 years of age (situation)
|
Cardiovascular
Risk Assessment Before Stem Cell Transplant
|
SNOMED-CT
|
· 414916001
· 238131007
· 365981007
· 439724007
· 438825005
|
· Obesity
(disorder)
· Overweight
(finding)
· Finding
of tobacco smoking behavior (finding)
· Family
history of cardiovascular disease in first degree male relative less than 55
years of age (situation)
· Family
history of cardiovascular disease in first degree female relative less than
65 years of age (situation)
|
Congestive
Heart Failure/Cardiomyopathy Evaluation
|
SNOMED-CT
|
· 414916001
· 238131007
· 365981007
· 433305001
|
· Obesity
(disorder)
· Overweight
(finding)
· Finding
of tobacco smoking behavior (finding)
· Family
history of congestive heart failure (situation)
|
Cardiovascular
Risk Assessment before Chemotherapy, Targeted Therapy, Immunotherapy
|
SNOMED-CT
|
· 414916001
· 238131007
· 365981007
· 110483000
· 85931000119105
|
· Obesity
(disorder)
· Overweight
(finding)
· Finding
of tobacco smoking behavior (finding)
· Tobacco
user (finding)
· History
of tobacco use in remission less than 12 months (situation)
|
Reason/Justification
for Ontology and Code Selection
The ontology chosen for this
section is SNOMED-CT. The selection of this ontology was primarily due to it
being a domain ontology. The codes provided are all parent codes with child
code associations. This would allow for more seamless extractions of identifiers
across multiple systems depending if the disparate systems have the ontologies
mapped appropriately to capture associations between the different codes. The
codes I selected and reason for multiple use is due to my findings. Based on
the clinical criteria for most cardiac issues the precursors do not vary. For
the most part precursors for identifying at risk patients are the weight,
tobacco usage, family history, age, diet, and treatment plan.
3. Flow Chart
a.
Flow chart is an interface between two disparate
databases using SNOMED CT as the common domain ontology and mapping the two to
receive required information to identify clinical factors.
b.
Flow chart represents a input into the referring physician HER
database and identifies a an extraction from the HER assuming the HER is
internal and placing into the attending physicians her to reflect in the
patient history. If the defined code is not identified, then the code is rejected.
4. Use Cases
References
Chow,
E. J., Chen, Y., Hudson, M. M., Feijen, E., Kremer, L. C., Border, W. L., …
Yasui, Y. (2018). Prediction of Ischemic Heart Disease and Stroke in Survivors
of Childhood Cancer. Journal of
clinical oncology : official journal of the American Society of Clinical
Oncology, 36(1),
44–52. doi:10.1200/JCO.2017.74.8673
Hamo,
C. E., Bloom, M. W., Cardinale, D., Ky, B., Nohria, A., Baer, L., … Butler, J.
(2016). Cancer Therapy-Related Cardiac Dysfunction and Heart Failure: Part 2:
Prevention, Treatment, Guidelines, and Future Directions. Circulation. Heart failure, 9(2), e002843.
doi:10.1161/CIRCHEARTFAILURE.115.002843
Herrmann,
J., Lerman, A., Sandhu, N. P., Villarraga, H. R., Mulvagh, S. L., & Kohli,
M. (2014). Evaluation and management of patients with heart disease and cancer:
cardio-oncology. Mayo Clinic
proceedings, 89(9),
1287–1306. doi:10.1016/j.mayocp.2014.05.013
Pletcher,
M.J., & Moran, A.E. (2017). Cardiovascular Risk Assessment. Medical
Clinics of North America, 101(4), 673-688. Retreived from https://www-clinicalkey-com.proxy.cc.uic.edu/service/content/pdf/watermarked/1-s2.0-S0025712517300251.pdf?locale=en_US&searchIndex=
Taylor,
C., & Darby, S.C.(2014) Ischemic
Heart Disease and Breast Cancer Radiotherapy. JAMA Intern Med, 174(1), 160-161.
doi:10.1001/jamainternmed.2013.9131
