Effectiveness of a Cardiovascular Health Electronic Health Record Application for Cancer Survivors in Community Oncology Practice: Results From WF-1804CD

Guidelines recommend cardiovascular (CV) risk assessment and counseling for cancer survivors. This study evaluated the automated heart-health assessment (AH-HA) clinical decision support tool to promote provider-patient CV health (CVH) discussions in outpatient oncology.PURPOSEGuidelines recommend c...

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Published in:	Journal of clinical oncology p. JCO2400342
Main Authors:	Weaver, Kathryn E., Dressler, Emily V., Klepin, Heidi D., Lee, Simon C., Wells, Brian J., Smith, Sydney, Hundley, W. Gregory, Lesser, Glenn J., Nightingale, Chandylen L., Turner, Julie C., Lackey, Ian, Heard, Kevin, Foraker, Randi, Wells, Brian, Klepin, Heidi, Payne, Philip, Lai, Albert, Lee, Simon Craddock, Carlson, Jay W., Hernandez, Marcia L., Hanna, Jenny, Rodgers, Heide Alexandra, Varghese, Sonia J., Throckmorton, Alyssa D., Panikkar, Rajiv, Ronjon, Paula, Lukenbill, Joshua, Stroh, Ann Louise, Onitilo, Adedayo A., Kulbacki, Lindsey W., Matin, Khalid, Hackney, Mary Helen
Format:	Journal Article
Language:	English
Published:	21-11-2024
Online Access:	Get full text
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Summary:	Guidelines recommend cardiovascular (CV) risk assessment and counseling for cancer survivors. This study evaluated the automated heart-health assessment (AH-HA) clinical decision support tool to promote provider-patient CV health (CVH) discussions in outpatient oncology.PURPOSEGuidelines recommend cardiovascular (CV) risk assessment and counseling for cancer survivors. This study evaluated the automated heart-health assessment (AH-HA) clinical decision support tool to promote provider-patient CV health (CVH) discussions in outpatient oncology.The AH-HA trial (WF-1804CD), coordinated by the Wake Forest National Cancer Institute Community Oncology Research Program Research Base, randomized practices to the AH-HA tool or usual care (UC) and enrolled survivors receiving routine care ≥6 months after curative cancer treatment. The tool displayed American Heart Association Life's Simple 7 CVH factors (BMI, physical activity, diet, smoking status, blood pressure, cholesterol, and glucose), populated from the electronic health record (EHR), alongside cancer treatments received with cardiotoxic potential. The primary end point was survivor-reported discussion of nonideal or missing CVH factors. A mixed-effects logistic regression model assessed the effect of AH-HA on CVH discussions, adjusting for practice.METHODSThe AH-HA trial (WF-1804CD), coordinated by the Wake Forest National Cancer Institute Community Oncology Research Program Research Base, randomized practices to the AH-HA tool or usual care (UC) and enrolled survivors receiving routine care ≥6 months after curative cancer treatment. The tool displayed American Heart Association Life's Simple 7 CVH factors (BMI, physical activity, diet, smoking status, blood pressure, cholesterol, and glucose), populated from the electronic health record (EHR), alongside cancer treatments received with cardiotoxic potential. The primary end point was survivor-reported discussion of nonideal or missing CVH factors. A mixed-effects logistic regression model assessed the effect of AH-HA on CVH discussions, adjusting for practice.Five UC and four AH-HA practices enrolled 645 survivors (82% breast, 8% endometrial, 5% colorectal, and 5% lymphoma, prostate, or multiple types) from October 1, 2020, to February 28, 2023. Most survivors were female (96%; 84% White/non-Hispanic, 8% Black; 3% Hispanic). Nearly all survivors (98%) in AH-HA practices reported a discussion for ≥1 nonideal or missing CVH factor compared with 55% in UC (P < .001). The average number of survivor-reported factors discussed was higher in AH-HA compared with UC (mean, 4.06 v 1.27; P < .001), as were EHR-documented discussions (3.83 v 0.77; P = .03). Survivors in AH-HA practices were also significantly more likely to report a recommendation to see a primary care provider (39%) compared with UC practices (25%, P = .02). Reported recommendations to see a cardiologist were low (approximately 6%) and did not differ between groups.RESULTSFive UC and four AH-HA practices enrolled 645 survivors (82% breast, 8% endometrial, 5% colorectal, and 5% lymphoma, prostate, or multiple types) from October 1, 2020, to February 28, 2023. Most survivors were female (96%; 84% White/non-Hispanic, 8% Black; 3% Hispanic). Nearly all survivors (98%) in AH-HA practices reported a discussion for ≥1 nonideal or missing CVH factor compared with 55% in UC (P < .001). The average number of survivor-reported factors discussed was higher in AH-HA compared with UC (mean, 4.06 v 1.27; P < .001), as were EHR-documented discussions (3.83 v 0.77; P = .03). Survivors in AH-HA practices were also significantly more likely to report a recommendation to see a primary care provider (39%) compared with UC practices (25%, P = .02). Reported recommendations to see a cardiologist were low (approximately 6%) and did not differ between groups.The AH-HA tool was effective at promoting CVH discussions during routine follow-up care for survivors and recommendations to consult primary care.CONCLUSIONThe AH-HA tool was effective at promoting CVH discussions during routine follow-up care for survivors and recommendations to consult primary care.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0732-183X 1527-7755 1527-7755
DOI:	10.1200/JCO.24.00342