||5R01CA226078-03 Interpret this number
||Wake Forest University Health Sciences
||Assessing Efficacy and Implementation of an Ehr Tool to Assess Heart Health Among Survivors
Cardiovascular (CV) disease is a significant competing cause of death for many survivors of common
early-stage cancers. Up to 90% of survivors have multiple CV risk factors, and many receive cancer
therapies with potentially cardiotoxic side effects. Yet cardiovascular health (CVH) is rarely addressed
during routine post-treatment survivorship care. CVH assessment could increase patient and provider
awareness of CVH and treatment-related cardiotoxicity risk, and promote CVH and cardiotoxicity
management during survivorship care, thereby reducing CV disease and cancer recurrence. Such an
assessment may be especially critical for the 20% of survivors who do not have a primary care provider
and those who received potentially cardiotoxic treatments. Our
research team developed an automated
health record (EHR)-based CVH assessment tool, deployed it in a primary care setting, and
adapted it for use with cancer survivors. Here we propose to implement and evaluate this
tool, called the Automated Heart Health Application (AH-HA), among survivors in the NCI
Oncology Research Program (NCORP) network. Evaluations in our pilot indicated high
and acceptability among oncology providers and survivors. AH-HA incorporates traditional CV risk
and potentially cardiotoxic cancer treatment data, and can be easily implemented into routine
practice. Thus, we propose a mixed methods, hybrid effectiveness-implementation study to
the effects of the AH-HA tool among survivors of breast, prostate, colorectal, and endometrial
who are now in survivorship care.Our central hypothesis is that the AH-HA tool will increase (1)
CVH awareness and discussions among patients and oncology providers, (2) appropriate referrals and
visits to primary care and cardiology, and (3) CV risk reduction and health promotion activities compared to
usual care. We seek to speed translation of the AH-HA tool into practice by simultaneously collecting
mixed method process data regarding current and future implementation, guided by the Reach, Efficacy,
Adoption, Implementation, and Maintenance (RE-AIM) framework. Our Specific Aims are to: (1) Assess
the impact of the AH-HA tool on providers' efforts to discuss CVH, refer survivors to primary care and
cardiology, and manage CV risk; (2) Measure the impact of the AH-HA tool on survivors' completed
primary care and cardiology visits and CVH; and (3) Examine factors influencing current and future
implementation of the AH-HA tool. The results of our proposed study will guide future dissemination efforts,
with the ultimate goal of improving CVH among the rapidly growing population of cancer survivors. Use of
the established NCORP network is efficient and provides an excellent opportunity to test our intervention in
community oncology settings, where most cancer survivors receive care.
Cardiovascular Assessment Tool for Breast Cancer Survivors and Oncology Providers: Usability Study.
, Klepin H.D.
, Wells B.J.
, Dressler E.V.
, Winkfield K.M.
, Lamar Z.S.
, Avery T.P.
, Pajewski N.M.
, Hundley W.G.
, Johnson A.
, et al.
JMIR cancer, 2021-01-21; 7(1), p. e18396.