Effectiveness of the Automated Heart-Health Assessment (AH-HA) tool on cardiovascular health improvements among post-treatment cancer survivors: 12-month results from WF-1804CD.

Abstract

12019 Background: Cardiovascular disease causes significant morbidity and mortality among US survivors. To enhance guideline recommended cardiovascular health (CVH) discussions during survivorship care, our team developed the EHR-based AH-HA clinical decision support tool, which displays modifiable CVH factors and cancer treatments with cardiotoxic potential. This tool significantly improved delivery of guideline-concordant CVH discussions, the primary study outcome; here we report AH-HA impacts on 12-month CVH improvements. Methods: The Wake Forest NCORP Research Base coordinated this practice-randomized clinical trial (NCT# 03935282) comparing AH-HA and usual care (UC) practices. Participants were survivors ≥ 6 months post-potentially curative treatment for breast, prostate, colorectal, endometrial cancers, or lymphoma, scheduled for routine follow-up. The AH-HA tool, based on the American Heart Association (AHA) Life’s Simple 7, aimed to enhance CVH awareness and action by providers and survivors. At AH-HA practices, providers used the tool with survivors during an outpatient oncology visit. CVH data were collected from the EHR and survivors (diet quality & physical activity) at baseline and 12 months. Outcomes included Simple 7 total CVH score (0-100, using AHA algorithm) and meaningful change in individual CVH factors (Table). Generalized estimating equations calculated rates of clinically meaningful improvements in CVH factors at 12 months by group, adjusting for cancer type and clustering within practice. Results: 645 survivors (82.3% breast cancer; 96.0% female; 83.9% white non-Hispanic, 7.8% Black, 3.7% Hispanic) enrolled at 9 practices (5 UC and 4 AH-HA). The total CVH score did not significantly change from baseline or between groups (Table 1, p>.05). Within the AH-HA arm, 20.3% of survivors achieved 5% weight reduction compared to 12.6% in UC; physical activity also improved more in the AH-HA arm, but not significantly. Rates were similar between arms for diet, blood pressure, and hemoglobin A1c. Conclusions: In addition to facilitating guideline concordant CVH discussions, AH-HA shows promise for encouraging weight loss among survivors. It is notable that a brief intervention delivered as part of standard oncology care impacted weight reduction. Clinical trial information: NCT03935282 . 12 month cardiovascular health outcomes among post-treatment survivors. CVH Outcomes  AH-HA  4 practices,  (n=281) Usual Care   5 practices, (n=342) Adj P-value  Improvement, % Yes         BMI (5% weight ↓)  20.3 12.6  0.02   Blood Pressure (5 mm ↓)  53.1 52.0 0.75 Physical Activity (+ 30 mins)  40.9 34.3 0.14 Healthy Diet Score (0-1 to 2-5, or 2-3 to 4-5 components)  21.7 18.9 0.45  Cholesterol (20% ↓)  8.6 9.6  # A1c (0.5% ↓)  8.9 8.8  0.97  Change in total CVH Score adjusted for baseline (positive=improvement) 0.9   -0.5   0.28   #Model did not converge due to small sample size.