Cardiology · Oncology
HFA-ICOS Baseline Risk before HER2-Targeted Therapy calculator
Enter the published formula inputs below to calculate and interpret this score.
Clinical inputs
Allowed range: 18–110 years
Age 80 years or older is high risk. Age 65 through 79 is a medium-2 factor. Under 65, age adds no points.
Allowed range: 5–80 %
Ejection fraction under 50% is high risk. From 50% through 54% is a medium-2 factor.
Allowed range: 60–260 mmHg
Systolic pressure above 140 mmHg or diastolic pressure above 90 mmHg counts as hypertension. Values of 140 and 90 do not.
Allowed range: 30–160 mmHg
Systolic pressure above 140 mmHg or diastolic pressure above 90 mmHg counts as hypertension. Values of 140 and 90 do not.
Allowed range: 4–20 %
Hemoglobin A1c above 7.0% counts as diabetes. A value of 7.0% does not.
Allowed range: 1–200 mL/min/1.73 m²
Estimated glomerular filtration rate under 60 is a medium-1 factor. A value of 60 is not.
Allowed range: 10–80 kg/m²
Body mass index above 30 kg/m² is a medium-1 factor. A value of 30 is not.
Result
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Clinical inputs
- Heart failure or cardiomyopathy
- Myocardial infarction or coronary bypass
- Stable angina
- Severe valvular heart disease
- Atrial fibrillation, flutter, or ventricular tachyarrhythmia
- Troponin above the local upper limit
- Natriuretic peptide above the local upper limit
- Anthracycline timing with HER2 therapy
- Prior trastuzumab cardiotoxicity
- Prior anthracycline for an earlier malignancy
- Prior radiotherapy to the left chest or mediastinum
- Age (years)Accepted range: 18 to 110
- Left ventricular ejection fraction (%)Accepted range: 5 to 80
- Systolic blood pressure (mmHg)Accepted range: 60 to 260
- Diastolic blood pressure (mmHg)Accepted range: 30 to 160
- On treatment for hypertension
- Hemoglobin A1c (%)Accepted range: 4 to 20
- On treatment for diabetes
- Estimated glomerular filtration rate (mL/min/1.73 m²)Accepted range: 1 to 200
- Current smoking or a substantial smoking history
- Body mass index (kg/m²)Accepted range: 10 to 80
Primary source
Lyon AR et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies. Eur J Heart Fail. DOI: 10.1002/ejhf.1920. PMID: 32463967. Table 3, HER2-targeted therapies (trastuzumab, pertuzumab, T-DM1, lapatinib, neratinib). Very high: heart failure or cardiomyopathy, prior trastuzumab cardiotoxicity. High: myocardial infarction or CABG, stable angina, severe valvular disease, LVEF under 50%, age 80 or older, and anthracycline given concurrently with trastuzumab. Medium 2: LVEF 50–54%, atrial fibrillation or flutter or ventricular tachycardia or fibrillation, troponin above the local upper limit, BNP or NT-proBNP above the local upper limit, age 65–79, prior anthracycline for a previous malignancy, prior left-chest or mediastinal radiotherapy. Medium 1: hypertension, diabetes, eGFR under 60, anthracycline before HER2-targeted therapy in the current regimen, smoking, BMI above 30. Blood pressure, HbA1c, and eGFR thresholds match the anthracycline table. Low risk is no risk factor or a single medium-1 factor. Medium risk is medium factors that add to 2 to 4 points. High risk is any high-risk factor or medium factors that add to 5 or more points. Very high risk is any very high-risk factor. Medium 1 counts 1 point and medium 2 counts 2 points. A single age and a single ejection fraction contribute only the highest matching row. (2020)
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