Designing a novel ProActive-CV clinic model to address cardiovascular risk in prostate cancer survivorship at a large safety-net hospital.

Abstract

e23224 Background: Prostate cancer (PCa) is the most common cancer in males. As survival rates increase, management strategies must adapt to address long-term care, especially of cardiovascular disease exacerbated by PCa treatment. Socioeconomically disadvantaged and minority populations, with a higher prevalence of cardiovascular risk factors (CVRFs), are especially at risk of poor cardiovascular outcomes. Oncologists, while focusing on active PCa, may struggle to manage CVRFs. This project aims to identify a cohort of PCa patients with active but stable disease to enroll in a newly designed collaborative survivorship clinic (ProActive-CV), co-led by oncologists and Advanced Practice Providers, purposed to optimize the health system while addressing CVRFs to decrease major adverse cardiac events (MACE). Methods: PCa patients followed by medical oncology at Parkland Health over a five-year period from 2018 to 2023 were identified using International Classification of Disease, Tenth Revision codes. Patients with a prostate-specific antigen (PSA) ≤0.05 ng/dL three consecutive times, three months apart on most recent labs were established as candidates for ProActive-CV clinic. We manually reviewed electronic medical records to identify CVRFs such as current or former smoker, body mass index ≥ 30 kg/m 2 , diabetes mellitus, hypertension, hyperlipidemia, heart failure, arrhythmia, and coronary artery disease. We also recognized MACE, including death from any cause, myocardial infarction, stroke, or urgent revascularization. Results: Of the 223 PCa patients identified, 73 (33%) met enrollment criteria for ProActive-CV. The median age of participants was 67 years, with a median follow-up of 29 months. 38 (52%) patients were Hispanic, 29 (40%) black or African American, 5 (7%) white, and 1 (1%) Asian. 24 (33%) had 0-2 CVRFs, 33 (45%) had 3-4, and 16 (22%) had 5 or more. 29 (40%) did not have a lipid panel checked in last year. 31 (42%) had a blood pressure ≥130/90 and 10 (14%) had a blood glucose ≥180 mg/dL at last appointment. MACE occurred in 9 (12%) patients, including 3 deaths, 4 myocardial infarctions, and 2 strokes. Conclusions: At a safety-net system with a large minority population, 33% of PCa patients followed by medical oncology benefit from enrollment in a novel ProActive-CV clinic by having a PSA ≤0.05 ng/dL three consecutive times, three months apart. Several care gaps were identified and provide opportunities for clinical emphasis. By establishing a PCa survivorship program with dedicated staff focused on CVRFs, healthcare systems can streamline provider scheduling while enhancing quality of care. CVRFs in candidates for ProActive-CV. CVRF Total Number, N=73 (%) Hypertension 61 (84) Hyperlipidemia 50 (68) Current or former smoker 40 (55) Body Mass Index ≥ 30 kg/m 2 32 (44) Diabetes mellitus 32 (44) Heart Failure 7 (10) Coronary Artery Disease 6 (8) Arrhythmia 6 (8)