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

本申请是根据特别利益通知（NOSI）提交的，该通知被确定为NOT-

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.