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Extending Automated Heart Health Assessment (AH-HA) for Cancer Survivors to Expand Provider and Patient Reach and Promote Sustainability

Award Number: R01CA226078
ORGANIZATION: NATIONAL CANCER INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 06/08/2018
PERIOD OF PERFORMANCE END DATE: 04/30/2031

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Extending Automated Heart Health Assessment (AH-HA) for Cancer Survivors to Expand Provider and Patient Reach and Promote Sustainability - Summary Clinical practice guidelines from oncology professional societies recommend cardiovascular health (CVH) assessment and discussion for patients during and after treatment. Despite its importance, most survivors do not receive guideline-based care. Given disparities in both cancer and cardiovascular outcomes, it is essential approaches to address CVH in survivors have impartial reach to improve care for survivors from all backgrounds and with all cancer types. We developed the Automated Heart Health Assessment (AH-HA) tool, an electronic health record (EHR) clinical decision support tool based on the American Heart Association’s CVH factors to promote provider-survivor CVH discussions in outpatient oncology and initiate the CVH care cascade for at-risk survivors. In the first phase, we completed a randomized type I hybrid effectiveness implementation trial of 645 survivors testing the effectiveness and acceptability of the AH-HA tool. CVH discussions among survivors enrolled in AH-HA compared to usual care (UC) practices almost doubled, and survivors in AH-HA practices were also more likely to receive a recommendation to see a primary care provider. In the renewal, we will expand reach and address sustainability by extending our partnership with NCI Community Oncology Research Program (NCORP) to conduct a type III hybrid effectiveness-implementation stepped wedge trial with 16 NCORP practices. In Aim 1, we will assess the impact of an enhanced AH-HA implementation package on overall and impartial reach (defined as discussion of ≥3 CVH factors documented in the EHR) among post-treatment cancer survivors sampled via chart review (N=1440). Impartial reach analyses will focus on documented discussion by age, race/ethnicity, sex, rural residence, and cancer type. We will also assess adoption at the survivor, provider, and practice levels. In Aim 2, we will measure the effectiveness of AH-HA on the CVH cascade of care: 1) CVH awareness (EHR data completeness and patient self-report), 2) CVH referral/treatment among survivors with poor CVH factors (CVH-relevant medications, lifestyle programs, referrals), and 3) CVH control/improvement among survivors with poor CVH factors. In Aim 3, we will assess maintenance in a subsequent cohort of N=576 survivors, evaluate implementation cost, and collect mixed methods data to assess sustainability from oncology providers. This competitive renewal builds upon promising results and key infrastructure including NCORP partnerships, AH-HA EHR integration within community oncology practices, and a productive study team. The renewal will extend the impact of our work by identifying implementation strategies to extend guideline-based care to more cancer survivors in the community and improve connections to address cardiovascular risk along the cascade of care (awareness, treatment, and control).


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $666,699 )
2026	2026	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	001	7	4/13/2026	COMPETING CONTINUATION	$725,479
2026	2024	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	000	6	12/8/2025	NON-COMPETING CONTINUATION	-$58,780
														Subtotal = $666,699

Issue Date FY: 2025 ( Subtotal = $0 )
2025	2024	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	000	6	12/18/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2024 ( Subtotal = $298,871 )
2024	2024	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	000	6	12/11/2023	NON-COMPETING CONTINUATION	$283,141
2024	2024	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	001	6	4/23/2024	NON-COMPETING CONTINUATION	$15,730
														Subtotal = $298,871

Issue Date FY: 2023 ( Subtotal = $170,155 )
2023	2023	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	001	5	4/4/2023	NON-COMPETING CONTINUATION	$3,403
2023	2023	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	000	5	3/16/2023	NON-COMPETING CONTINUATION	$166,752
														Subtotal = $170,155

Issue Date FY: 2022 ( Subtotal = $517,124 )
2022	2022	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	000	4	12/3/2021	NON-COMPETING CONTINUATION	$474,908
2022	2022	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	001	4	6/7/2022	NON-COMPETING CONTINUATION	$42,216
														Subtotal = $517,124

Issue Date FY: 2021 ( Subtotal = $530,058 )
2021	2021	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	000	3	11/13/2020	NON-COMPETING CONTINUATION	$503,556
2021	2021	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	001	3	3/15/2021	NON-COMPETING CONTINUATION	$26,502
														Subtotal = $530,058

Issue Date FY: 2020 ( Subtotal = $517,927 )
2020	2020	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	000	2	11/15/2019	NON-COMPETING CONTINUATION	$466,134
2020	2020	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	001	2	1/13/2020	NON-COMPETING CONTINUATION	$51,793
														Subtotal = $517,927

Issue Date FY: 2019 ( Subtotal = $0 )
2019	2018	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	000	1	5/29/2019	NEW	$0
														Subtotal = $0

Issue Date FY: 2018 ( Subtotal = $499,843 )
2018	2018	WAKE FOREST UNIVERSITY HEALTH SCIENCES	MEDICAL CENTER BLVD	WINSTON SALEM	NC	27157	FORSYTH	USA	Cancer Cause and Prevention Research	000	1	6/8/2018	NEW	$499,843
														Subtotal = $499,843

Grand Total All Awards = $3,200,677

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Extending Automated Heart Health Assessment (AH-HA) for Cancer Survivors to Expand Provider and Patient Reach and Promote Sustainability

Award Number: R01CA226078

ORGANIZATION: NATIONAL CANCER INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 06/08/2018

PERIOD OF PERFORMANCE END DATE: 04/30/2031

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