Novel tool helps foster cardiovascular health discussions with cancer survivors
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Key takeaways:
- Most physicians rated the assessment as easy to use.
- Oncology providers in the intervention group discussed nearly four times as many cardiovascular health factors with their patients.
CHICAGO — A novel clinical decision support tool appeared effective at promoting cardiovascular health discussions during routine follow-up care for cancer survivors, according to study results presented at ASCO Annual Meeting.
The Automated Heart-Health Assessment also led to more referrals to primary care, researchers found.
Rationale and methods
“My team recognized that for many post-treatment cancer survivors, heart disease may pose as great or even greater risk to their health than cancer recurrence,” Kathryn E. Weaver, PhD, MPH, professor in the departments of social sciences and health policy, implementation science, and translational science at Wake Forest University School of Medicine, told Healio. “At the same time, the focus of medical care for the past several years may have been on cancer, and survivors and their providers may not be aware of their current cardiovascular risk factors and how cancer treatment may have impacted these factors. ASCO and other professional organizations have published professional guidelines encouraging cardiovascular risk assessment for patients with cancer, and we wanted to make it easier for both patients and providers to have cardiovascular health information during routine post-treatment oncology care.”
The Automated Heart-Health Assessment (AH-HA) study evaluated a novel electronic health record clinical decision support tool based on the American Heart Association’s Simple 7 cardiovascular health factors to promote provider-patient cardiovascular health discussions in outpatient oncology.
Weaver and colleagues randomly assigned Wake Forest NCI Community Oncology Research Program (NCORP) oncology practices using the Epic EHR to the AH-HA tool plus provider education or usual care. They enrolled 645 survivors (mean age, 62 years; 82% breast cancer; 96% women; 84% white) receiving routine care at least 6 months post-curative cancer treatment (median time since diagnosis, 3.6 years).
Survivor-reported discussion of nonideal or missing cardiovascular health factors served as the primary endpoint. Secondary endpoints included documentation of cardiovascular health discussions, referrals to primary care and cardiology, and change in cardiovascular health factors over 1 year.
Researchers used a mixed-effects logistic regression model to assess the effect of the AH-HA tool on cardiovascular health discussions between the two groups.
Findings
Overall, 18 survivors did not complete necessary assessments, leaving 627 evaluable survivors.
Results showed nearly double the proportion of survivors in the AH-HA vs. usual care group reported having discussions with providers about at least one non-ideal or missing cardiovascular health factor (97.6% vs. 54.7%; P < .001).
In addition, the majority (87%) of providers rated the tool utility and ease of use positively.
“We were gratified to see that using the AH-HA tool was acceptable to both patients and their oncology providers as part of routine survivorship appointments,” Weaver said. “We had positive feedback from our physician and advanced practice enrolling providers about how the AH-HA tool was easy to incorporate into the clinic visit and positively impacted the care they delivered.”
She said the trial results surpassed researchers’ expectations.
“The rates of discussions about cardiovascular health factors — for example, blood pressure, diabetes, BMI, physical activity and diet — were between 50% and 60% higher in clinics with access to the AH-HA tool compared with clinics in the usual care group,” Weaver said. “Oncology providers in the intervention group discussed almost four times as many cardiovascular health factors with their patients, and this aligned with what was documented in the medical record. I was somewhat surprised that the intervention increased referrals to primary care, but not to cardiology, which probably reflects the central role for primary care in the long-term management of the risk factors highlighted in this tool.”
Implications
The findings suggest the AH-HA tool is an effective strategy for helping oncology providers meet clinical practice guidelines regarding cardiovascular health assessment after cancer treatment, Weaver told Healio.
“We are continuing to follow the more than 600 cancer survivors enrolled to understand the downstream impacts of using this tool in clinic with their provider,” she said. “We want to understand how it may influence what tests and follow-up care patients receive, as well as the impact on their cardiovascular health factors. We are also excited to work with our clinical partners to understand how best to scale this up in community oncology practice. We want to test strategies for helping oncology clinics and providers integrate the AH-HA tool into their practice so that we can reach more patients.”
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Weaver KE, et al. Abstract LBA12007. Presented at: ASCO Annual Meeting; June 2-6, 2023; Chicago.
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