Recommendations for patients with CV risk
| Atrial fibrillation |
| Determine whether the patient is high or low risk |
| Low-risk cases may be safely treated with BTKis |
| Favor more second-generation BTKis (acalabrutinib or zanubrutinib) or alternative treatments |
| BTKi treatment may be continued in consultation with MDT for patients with: |
| Permanent/persistent AF |
| HTN |
| History of myocardial infarction |
| BTKis NOT recommended for patients with: |
| History of ventricular arrhythmia |
| Family history of sudden cardiac death |
| Severe, uncontrolled HTN |
| Severe or uncontrolled congestive heart failure (LVEF <30%) |
| Hypertension |
| If HTN is well-controlled, BTKi therapy may be used |
| Monitor blood pressure at least biweekly for the first 3-6 mo of BTKi therapy |
| Maintain early threshold for treatment during BTKi therapy |
| CHF |
| Examine with echocardiogram |
| Restrict to <2 g daily sodium intake |
| Monitor weight daily |
| Monitor blood pressure twice weekly |
| Manage care with MDT (preferred) or in collaboration with a cardio-oncologist |
| Ventricular arrhythmias |
| Ibrutinib should be avoided |
| The risk of second-generation BTKis (acalabrutinib or zanubrutinib) is not currently known |
| Atrial fibrillation |
| Determine whether the patient is high or low risk |
| Low-risk cases may be safely treated with BTKis |
| Favor more second-generation BTKis (acalabrutinib or zanubrutinib) or alternative treatments |
| BTKi treatment may be continued in consultation with MDT for patients with: |
| Permanent/persistent AF |
| HTN |
| History of myocardial infarction |
| BTKis NOT recommended for patients with: |
| History of ventricular arrhythmia |
| Family history of sudden cardiac death |
| Severe, uncontrolled HTN |
| Severe or uncontrolled congestive heart failure (LVEF <30%) |
| Hypertension |
| If HTN is well-controlled, BTKi therapy may be used |
| Monitor blood pressure at least biweekly for the first 3-6 mo of BTKi therapy |
| Maintain early threshold for treatment during BTKi therapy |
| CHF |
| Examine with echocardiogram |
| Restrict to <2 g daily sodium intake |
| Monitor weight daily |
| Monitor blood pressure twice weekly |
| Manage care with MDT (preferred) or in collaboration with a cardio-oncologist |
| Ventricular arrhythmias |
| Ibrutinib should be avoided |
| The risk of second-generation BTKis (acalabrutinib or zanubrutinib) is not currently known |
LVEF, left ventricular ejection fraction; MDT, multidisciplinary team.