Grant Number:	2R01CA226078-07A1 Interpret this number
Primary Investigator:	Weaver, Kathryn
Organization:	Wake Forest University Health Sciences
Project Title:	Extending Automated Heart Health Assessment (Ah-Ha) for Cancer Survivors to Expand Provider and Patient Reach and Promote Sustainability
Fiscal Year:	2026

Summary Clinical practice guidelines from oncology professional societies recommend cardiovascular health (CVH) assessment and discussion for patients during and after treatment. Despite its importance, most survivors do not receive guideline-based care. Given disparities in both cancer and cardiovascular outcomes, it is essential approaches to address CVH in survivors have impartial reach to improve care for survivors from all backgrounds and with all cancer types. We developed the Automated Heart Health Assessment (AH-HA) tool, an electronic health record (EHR) clinical decision support tool based on the American Heart Association’s CVH factors to promote provider-survivor CVH discussions in outpatient oncology and initiate the CVH care cascade for at-risk survivors. In the first phase, we completed a randomized type I hybrid effectiveness implementation trial of 645 survivors testing the effectiveness and acceptability of the AH-HA tool. CVH discussions among survivors enrolled in AH-HA compared to usual care (UC) practices almost doubled, and survivors in AH-HA practices were also more likely to receive a recommendation to see a primary care provider. In the renewal, we will expand reach and address sustainability by extending our partnership with NCI Community Oncology Research Program (NCORP) to conduct a type III hybrid effectiveness-implementation stepped wedge trial with 16 NCORP practices. In Aim 1, we will assess the impact of an enhanced AH-HA implementation package on overall and impartial reach (defined as discussion of ≥3 CVH factors documented in the EHR) among post-treatment cancer survivors sampled via chart review (N=1440). Impartial reach analyses will focus on documented discussion by age, race/ethnicity, sex, rural residence, and cancer type. We will also assess adoption at the survivor, provider, and practice levels. In Aim 2, we will measure the effectiveness of AH-HA on the CVH cascade of care: 1) CVH awareness (EHR data completeness and patient self-report), 2) CVH referral/treatment among survivors with poor CVH factors (CVH-relevant medications, lifestyle programs, referrals), and 3) CVH control/improvement among survivors with poor CVH factors. In Aim 3, we will assess maintenance in a subsequent cohort of N=576 survivors, evaluate implementation cost, and collect mixed methods data to assess sustainability from oncology providers. This competitive renewal builds upon promising results and key infrastructure including NCORP partnerships, AH-HA EHR integration within community oncology practices, and a productive study team. The renewal will extend the impact of our work by identifying implementation strategies to extend guideline-based care to more cancer survivors in the community and improve connections to address cardiovascular risk along the cascade of care (awareness, treatment, and control).