Incorporating primary care factors into risk-stratified cardiovascular care for complex cancer survivors

将初级保健因素纳入复杂癌症幸存者的风险分层心血管护理中

• 批准号: 10165250
• 负责人: Bijal A. Balasubramanian
• 金额: $ 15万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-18 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10165250
• 关键词: Address; Age; Algorithms; American Heart Association; Antihypertensive Agents; Aspirin; Atherosclerosis; Blood Pressure; Breast Cancer Risk Factor; Cancer Survivor; Cancer Survivorship; Cardiac; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Cessation of life; Chemotherapy and/or radiation; Cholesterol; Chronic; Chronic Disease; Clinic; Clinical; Clinical Data; Clinical Management; Clinical Protocols; Colorectal Cancer; Complex; Computerized Medical Record; Consult; Data; Data Element; Diabetes Mellitus; Diagnosis; Disease; Disease Management; Event; Focus Groups; Future; Glycosylated hemoglobin A; Health; High Prevalence; Hospitals; Hypertension; Internal Medicine; Intervention; Interview; Lipids; Malignant Neoplasms; Measurement; Measures; Medical center; Modeling; Myocardial Infarction; Oncology; Outcome; Parents; Pathway interactions; Patients; Persons; Pharmaceutical Preparations; Physicians; Preventive Intervention; Primary Health Care; Primary Prevention; Principal Investigator; Process; Protocols documentation; Quality of Care; Race; Radiation therapy; Research Personnel; Risk; Risk Estimate; Risk Factors; Risk Management; Risk stratification; Severities; Smoking; Smoking History; Specialist; Stroke; Structure; Survivors; System; Texas; Universities; Visit; Work; blood pressure regulation; cancer diagnosis; cancer therapy; cardiovascular disorder risk; cardiovascular risk factor; care coordination; cohort; colorectal cancer treatment; comorbidity; design; ethnic minority population; high risk; improved; interest; malignant breast neoplasm; medication compliance; mortality; novel; parent grant; patient stratification; practical application; racial and ethnic; response; sex; survivorship; targeted treatment; tool; treatment effect; treatment risk; virtual

This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT- CA- 20-038. PROJECT SUMMARY/ABSTRACT Cardiovascular disease (CVD) is the leading non-cancer cause of death among cancer survivors. Increased risk may be due to specific cancer treatment effects (chemotherapies, radiation therapy, some targeted therapies), but is also amplified for cancer survivors with other common conditions that increase CVD risk, including diabetes, hypertension, smoking, and abnormal cholesterol. Among non-cancer patients, the American Heart Association’s Atherosclerotic Cardiovascular Disease (ASCVD) risk calculator combines these and other risk factors (age, sex, race) to estimate a 10-year risk of heart attack or stroke as a percentage. This ASCVD risk calculator is regularly used by primary care clinicians to identify patients who might benefit from CVD primary prevention interventions, such as statin therapy and improved blood pressure control. Further, electronic medical records systems (EMR) can automatically calculate the ASCVD risk at any given point, by drawing up readily available data elements needed for the risk estimator. The cohort of breast and colorectal cancer survivors at Parkland Health & Hospital System studied in the parent grant is notable for a high proportion of racial/ethnic minorities who have high rates of pre-existing cardiovascular disease risk factors - many of whom have had no primary care or suboptimal cardiovascular risk management before their cancer diagnosis. This project will: (Aim 1) assess cardiovascular disease risk for breast and colorectal cancer survivors by characterizing pre-cancer cardiovascular risk factors and cancer treatment risks, using EMR data; (Aim 2) Engage clinician and clinic staff leader stakeholders to develop (A) a risk-stratified algorithm to identify cancer survivors with elevated cardiovascular disease risk, and (B) to develop clinical management protocols for high-, medium-, and low-risk patients. These aims will leverage existing EMR measures of chronic disease management quality and primary care connectedness already collected in the parent grant. The results of this supplement will inform the design of a future R01 application of a wide-scale intervention to implement and evaluate the impact of a risk-stratified cardiovascular care algorithm in cancer survivorship. Dr. Hong, a general internal medicine physician-investigator at the University of Texas Southwestern Medical Center (UTSW), will work with Dr. Vlad Zaha, a cardiology physician investigator and cardio-oncology specialist, who studies and treats cancer survivors at the UTSW, in close partnership with the parent grant Principal Investigators, to complete this work.

该申请是根据特殊利益通知（NOSI）提交的 CA-20-038。 项目摘要/摘要 心血管疾病（CVD）是癌症存活中的主要非癌症死亡原因。风险增加 可能是由于特定的癌症治疗效应（化学疗法，放射治疗，一些靶向疗法）， 但也会因其他常见状况而增加CVD风险的癌症存活，包括 糖尿病，高血压，吸烟和异常胆固醇。在非癌症患者中，美国心脏 协会的动脉粥样硬化心血管疾病（ASCVD）风险计算器结合了这些风险和其他风险 因素（年龄，性别，种族）估计心脏病发作或中风的10年风险为百分比。此ASCVD风险 原始保健临床医生经常使用计算器来识别可能受益于CVD的患者 一级预防干预措施，例如他汀类药物治疗和改善血压控制。更远， 电子病历系统（EMR）可以在任何给定点自动计算ASCVD风险 绘制风险估计器所需的随时可用的数据元素。乳房和结直肠的队列 父母赠款的Parkland Health＆Hospital System Studiod的癌症冲浪者以高 既有心血管疾病危险因素的种族/少数民族的比例 许多人在癌症之前没有初级保健或次级心血管风险管理 诊断。该项目将：（目标1）评估乳腺癌和结直肠癌的心血管疾病风险 幸存者使用EMR数据来表征癌前心血管危险因素和癌症治疗风险； （目标2）让临床人员负责人利益相关者开发（a）一种风险分层算法 鉴定患有升高心血管疾病风险的癌症存活，以及（b）发展临床管理 高危患者，中等和低风险患者的方案。这些目标将利用现有的EMR测量 慢性疾病管理质量和初级保健联系已在父母赠款中收集。 该补充的结果将为您设计的R01应用程序的设计提供信息 实施和评估风险分层的心血管护理算法对癌症生存的影响。 洪博士，德克萨斯大学西南医学的一般内科医学治疗师 Center（UTSW）将与心脏病医师和心脏肿瘤学的Vlad Zaha博士合作 专家，与父母赠款密切合作研究和治疗UTSW的癌症生存 首席研究人员，完成这项工作。