{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:54:50Z","timestamp":1792684490312,"version":"4.5.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2014,1,27]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Adjuvant trastuzumab improves survival for women with human epidermal growth factor receptor 2\u2010positive breast cancer, but increases risk for heart failure (\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              ) and cardiomyopathy (\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              ). However, clinical trials may underestimate\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              \/\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              risk because they enroll younger subjects with fewer cardiac risk factors. We sought to develop a clinical risk score that identifies older women with breast cancer who are at higher risk of\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              or\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              after trastuzumab.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Using the Surveillance, Epidemiology and End Results (\n              <jats:styled-content style=\"fixed-case\">SEER<\/jats:styled-content>\n              )\u2010Medicare database, we identified women with breast cancer who received adjuvant trastuzumab. Using a split\u2010sample design, we used a proportional hazards model to identify candidate predictors of\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              \/\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              in a derivation cohort. A risk score was constructed using regression coefficients, and\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              \/\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              rates were calculated in the validation cohort. The sample consisted of 1664 older women (mean age 73.6\u00a0years) with 3\u2010year\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              \/\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              rate of 19.1%. A risk score consisting of age, adjuvant chemotherapy, coronary artery disease, atrial fibrillation or flutter, diabetes mellitus, hypertension, and renal failure was able to classify\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              \/\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              risk into low (0 to 3 points), medium (4 to 5 points), and high (\u22656 points) risk strata with 3\u2010year rates of 16.2%, 26.0%, and 39.5%, respectively.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A 7\u2010factor risk score was able to stratify 3\u2010year risk of\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              \/\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              after trastuzumab between the lowest and highest risk groups by more than 2\u2010fold in a Medicare population. These findings will inform future research aimed at further developing a clinical risk score for\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              \/\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              for breast cancer patients of all ages.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.113.000472","type":"journal-article","created":{"date-parts":[[2014,3,1]],"date-time":"2014-03-01T05:56:36Z","timestamp":1393653396000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":234,"title":["Risk Prediction Model for Heart Failure and Cardiomyopathy After Adjuvant Trastuzumab Therapy for Breast Cancer"],"prefix":"10.1161","volume":"3","author":[{"given":"Ghideon","family":"Ezaz","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica B.","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, CT"},{"name":"Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine and Yale Comprehensive Cancer Center, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cary P.","family":"Gross","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, CT"},{"name":"Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine and Yale Comprehensive Cancer Center, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jersey","family":"Chen","sequence":"additional","affiliation":[{"name":"Kaiser Permanente, Mid\u2010Atlantic Permanente Research Institute, Rockville, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0910383"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa052122"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa052306"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.20.5.1215"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djs317"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.07.068"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.10.4976"},{"key":"e_1_3_5_9_2","unstructured":"National Cancer Institute . 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