HFA-ICOS Cardio-Oncology Risk Assessment for Anthracyclines
HFA-ICOS baseline cardiovascular toxicity risk before anthracycline chemotherapy (Lyon 2020; ESC 2022 cardio-oncology guidelines). Classifies patients as low, medium, high or very high risk from the highest risk factor present and the total of medium-risk points.
Score interpretation
HFA-ICOS low risk: estimated cardiotoxicity risk < 2% (expert opinion, Lyon 2020).
→ Proceed with treatment; baseline echo and standard cardiovascular surveillance per local and international guidelines.
HFA-ICOS medium risk: estimated cardiotoxicity risk 2-9%.
→ Closer cardiovascular monitoring during treatment (echo and troponin/natriuretic peptide); consider cardio-oncology or cardiology referral.
HFA-ICOS high risk: estimated cardiotoxicity risk 10-19%.
→ Cardio-oncology assessment before treatment to optimise cardiovascular disease and risk factors and plan surveillance; cardioprotective strategies. Do not withhold effective cancer treatment without MDT discussion.
HFA-ICOS very high risk: estimated cardiotoxicity risk 20% or more.
→ Specialist cardio-oncology review before treatment; MDT discussion of alternative non-anthracycline regimens; if none, maximum cardioprotection and intensive monitoring throughout.
Interpretation bands for the HFA-ICOS. Apply clinical judgement and local guidance.
References
- Lyon AR, et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society. Eur J Heart Fail. 2020;22(11):1945-1960.
- Lyon AR, et al. 2022 ESC Guidelines on cardio-oncology. Eur Heart J. 2022;43(41):4229-4361.
Related
Curated clinical cross-links plus same-class fallbacks.
- Idarubicin (Specialist drug) · Anthracycline chemotherapy
- Lidocaine IV (Cardiac Arrhythmia) · Antiarrhythmic
- Protamine Sulphate (Heparin Reversal) · Heparin Reversal / Cardiac Surgery
- Mavacamten · Cardiac myosin inhibitor
- Folinic Acid (Calcium Folinate / Leucovorin) · Antidote / Chemotherapy Support
- Zoledronic Acid · Bisphosphonate (IV)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.