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

本申请是为回应特别利益通知(NOSI)而提出的，该通知被确认为非- CA-20-038。 项目摘要/摘要 心血管疾病(CVD)是癌症幸存者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果(化疗、放射治疗、一些靶向治疗)， 但对于患有其他增加心血管风险的常见疾病的癌症幸存者来说，这一点也会放大，包括 糖尿病、高血压、吸烟和胆固醇异常。在非癌症患者中，美国心脏 协会的动脉粥样硬化性心血管疾病(ASCVD)风险计算器将这些风险和其他风险结合在一起 因素(年龄、性别、种族)，以百分比形式估计10年内心脏病发作或中风的风险。这种ASCVD风险 初级保健临床医生经常使用计算器来识别可能受益于心血管疾病的患者 主要预防干预措施，如他汀类药物治疗和改善血压控制。此外， 电子病历系统(EMR)可以通过以下方式自动计算任何给定点的ASCVD风险 拟定风险估计者所需的现成数据元素。乳房和结直肠癌的队列 Parkland Health&Hospital System的癌症幸存者在父母赠款中的研究表明， 先前存在心血管疾病风险因素比率较高的种族/少数族裔的比例- 他们中的许多人在患癌症之前没有接受过初级保健或心血管风险管理不佳 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 通过使用EMR数据，确定癌症前心血管危险因素和癌症治疗风险的特征； (目标2)让临床医生和诊所员工领导利益相关者制定(A)风险分层算法，以 确定心血管疾病风险升高的癌症幸存者，以及(B)开发临床管理 高危、中危和低危患者的治疗方案。这些目标将利用现有的EMR措施 慢性病管理质量和初级保健连接性已在父母补助金中收集。 这一补充的结果将为未来R01大规模干预应用的设计提供参考 实施和评估风险分层心血管护理算法对癌症存活率的影响。 洪博士是德克萨斯大学西南医学大学的普通内科医生兼研究员 中心(UTSW)，将与心脏内科医生兼心脏肿瘤学研究员弗拉德·扎哈博士合作 在UTSW研究和治疗癌症幸存者的专家，与父母赠款密切合作 首席调查员，完成这项工作。

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.