Addressing cancer survivors’ cardiovascular health using the automated heart health assessment (AH-HA) EHR tool: Initial protocol and modifications to address COVID-19 challenges

Foraker, Randi E.; Davidson, Eleanor C; Dressler, Emily V.; Wells, Brian J.; Lee, Simon J. Craddock; Klepin, Heidi D.; Winkfield, Karen M.; Hundley, W. Gregory; Payne, Philip R. O.; Lai, Albert M.; Lesser, Glenn J.; Weaver, Kathryn E.

doi:10.1016/j.conctc.2021.100808

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…36 Health information technology might help support PCPs in providing survivorship care. [37][38][39][40] Welldesigned clinical decision support tools integrated into electronic health records (EHR) could provide a summary to PCPs of the patient's cancer diagnosis, and alert PCPs on recommendations for survivorship care based on current guidelines. 37,39,40 41 Pulling data from EHRs to create more tailored plans may also increase patient adherence to behavior change interventions.…”

Section: Discussionmentioning

confidence: 99%

Use of Cancer Survivorship Care Guidelines by Primary Care Providers in the United States

Townsend,

Rohan,

Sabatino

et al. 2023

J Am Board Fam Med

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Background: National organizations have issued comprehensive cancer survivorship care guidelines to improve care of cancer survivors, many of whom receive care from primary care providers (PCPs).Methods: We analyzed Porter Novelli's 2019 fall DocStyles survey to assess use of cancer survivorship care guidelines, receipt of survivorship training, types of survivorship services provided, and confidence providing care among PCPs in the United States. We grouped PCPs by use of any guideline ("users") versus no guideline use ("nonusers"). We calculated descriptive statistics and conducted multivariable logistic regression analyses to examine guideline use, having received training on providing survivorship care services, and confidence in providing care. Within the panel, sampling quotas were set so that 1000 primary care physicians, 250 OB/GYNs, 250 pediatricians, and 250 nurse practitioners/ physician assistants were recruited.Results: To reach selected quotas, 2696 health professionals were initially contacted to participate, resulting in a response rate of 64.9%. Sixty-two percent of PCPs reported using guidelines and 17% reported receiving survivorship care training. Use of any guidelines or receiving training was associated with reporting providing a range of survivorship services and confidence in providing care. After adjusting for demographic characteristics, guideline users were more likely than nonusers to report assessing genetic cancer risk (OR ¼ 2.65 95% confidence interval (CI) (1.68, 4.17)), screening for cancer recurrence (OR ¼ 2.32 95% CI (1.70, 3.18)) or a new cancer (OR ¼ 1.63, 95% CI (1.20, 2.22)), and treating depression (OR ¼ 1.64, 95% CI (1.20, 2.25)). Receipt of training was also positively associated with providing genetic risk assessment, surveillance for recurrence, as well as assessing late/long-term effects, and treating pain, fatigue, and sexual side effects.Conclusion: Survivorship care guidelines and training support PCPs in providing a range of survivorship care services.

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Section: Discussionmentioning

confidence: 99%

Use of Cancer Survivorship Care Guidelines by Primary Care Providers in the United States

Townsend,

Rohan,

Sabatino

et al. 2023

J Am Board Fam Med

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“…This cross-sectional analysis utilized baseline data from participants in an ongoing study to examine the effects of the AH- HA tool among survivors receiving routine follow-up care in community oncology settings, using a group-randomized trial design [ 34 ]. This study was conducted in partnership with 9 outpatient oncology practices affiliated with the Wake Forest NCI Community Oncology Research Program (WF NCORP) Research Base (NCT03935282, registered 10/01/2020).…”

Section: Methodsmentioning

confidence: 99%

“…We present baseline data from an ongoing hybrid effectiveness-implementation study (WF-1804CD) of a novel electronic health record (EHR)-embedded heart health assessment tool, Automated Heart-Health Assessment (AH-HA) [ 13 , 29 , 32 , 33 ]. The AH-HA trial collects data on CVH factors and care coordination among cancer survivors receiving routine survivorship care in NCI Community Oncology Research Program (NCORP) outpatient oncology practices [ 34 ]. The AH-HA tool assesses the American Heart Association’s Life’s Simple 7 CVH factors [ 35 ] (body mass index, smoking status, blood pressure (BP), total cholesterol, hemoglobin A1c (HbA1c) or blood glucose, physical activity, and diet) using a combination of self-report and EHR data.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular health assessment in routine cancer follow-up in community settings: survivor risk awareness and perspectives

Weaver,

Dressler,

Smith

et al. 2024

BMC Cancer

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Background Guidelines recommend cardiovascular risk assessment and counseling for cancer survivors. For effective implementation, it is critical to understand survivor cardiovascular health (CVH) profiles and perspectives in community settings. We aimed to (1) Assess survivor CVH profiles, (2) compare self-reported and EHR-based categorization of CVH factors, and (3) describe perceptions regarding addressing CVH during oncology encounters. Methods This cross-sectional analysis utilized data from an ongoing NCI Community Oncology Research Program trial of an EHR heart health tool for cancer survivors (WF-1804CD). Survivors presenting for routine care after potentially curative treatment recruited from 8 oncology practices completed a pre-visit survey, including American Heart Association Simple 7 CVH factors (classified as ideal, intermediate, or poor). Medical record abstraction ascertained CVD risk factors and cancer characteristics. Likert-type questions assessed desired discussion during oncology care. Results Of 502 enrolled survivors (95.6% female; mean time since diagnosis = 4.2 years), most had breast cancer (79.7%). Many survivors had common cardiovascular comorbidities, including high cholesterol (48.3%), hypertension or high BP (47.8%) obesity (33.1%), and diabetes (20.5%); 30.5% of survivors received high cardiotoxicity potential cancer treatment. Less than half had ideal/non-missing levels for physical activity (48.0%), BMI (18.9%), cholesterol (17.9%), blood pressure (14.1%), healthy diet (11.0%), and glucose/ HbA1c (6.0%). While > 50% of survivors had concordant EHR-self-report categorization for smoking, BMI, and blood pressure; cholesterol, glucose, and A1C were unknown by survivors and/or missing in the EHR for most. Most survivors agreed oncology providers should talk about heart health (78.9%). Conclusions Tools to promote CVH discussion can fill gaps in CVH knowledge and are likely to be well-received by survivors in community settings. Trial registration NCT03935282, Registered 10/01/2020

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Dose-response association between cardiovascular health and mortality in cancer survivors

López-Bueno,

Yang,

Calatayud

et al. 2024

Current Problems in Cardiology

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Addressing cancer survivors’ cardiovascular health using the automated heart health assessment (AH-HA) EHR tool: Initial protocol and modifications to address COVID-19 challenges

Cited by 7 publications

References 22 publications

Use of Cancer Survivorship Care Guidelines by Primary Care Providers in the United States

Use of Cancer Survivorship Care Guidelines by Primary Care Providers in the United States

Cardiovascular health assessment in routine cancer follow-up in community settings: survivor risk awareness and perspectives

Dose-response association between cardiovascular health and mortality in cancer survivors

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