CARDIOVASCULAR disease may pose a greater risk to many post-treatment survivors of cancer than cancer recurrence, claimed Kathryn Weaver, Wake Forest University School of Medicine, North Carolina, USA, at the American Society for Clinical Oncology (ASCO) Annual Meeting 2023. Weaver and team aim to assist both patients and providers to have access to cardiovascular health information during routine post-treatment oncology care. They stated that the AH-HA study led to more referrals to primary care.
The AH-HA study assessed a new electronic health record clinical decision support tool, established on the American Heart Association’s (AHA) Simple 7 cardiovascular health factors, to foster provider-patient cardiovascular health discussions in outpatient oncology. The researchers randomly assigned Wake Forest NCI Community Research Programme (NCORP) oncology practices utilising the Epic HER to the AH-HA tool plus provider education or usual care. A total of 645 survivors of cancer were enrolled (mean age: 62 years; 82% breast cancer; 96% female; 84% White). All participants had received routine care at least 6 months post-curative cancer treatment, with a median time since diagnosis of 3.6 years.
The primary endpoint was the survivor-reported discussion of non-ideal or missing cardiovascular health factors, while the secondary endpoints included documentation of cardiovascular health discussions, referrals to primary care and cardiology, and chance in cardiovascular health factors over 1 year. The researchers utilised a mixed-effects logistic regression model to evaluate the effect of the AH-HA tool on cardiovascular health discussion between two groups. Out of the 645 survivors, 18 did not fulfil the necessary assessments, leaving 627 evaluable survivors.
Nearly double the proportion of survivors in the AH-HA group, versus the usual care group, reported having discussions with providers about at least one non-ideal or missing cardiovascular health factor (97.6% versus 54.7%; p<0.001). Most providers (87%) provided a positive evaluation of the tool utility and ease of use.
Discussions about cardiovascular health factors, including blood pressure, diabetes, BMI, physical activity, and diet had between 50–60% higher rates in clinics with access to the AH-HA tool, compared with clinics in the usual care group. In the intervention group, the oncology providers discussed almost four times as many cardiovascular health factors with their patients, and this aligned with what was documented in the medical record.
The authors expressed their surprise that the intervention increased referrals to primary care, rather than cardiology. They stated that this probably reflects the central role for primary care in the long-term management of the risk factors highlighted in this tool. The research team are currently continuing to follow more than 600 survivors of cancer enrolled to elucidate the downstream impacts of using this tool in clinics with their providers.
