Acceptability of the AH-HA cardiovascular health assessment tool among oncology providers and post-treatment cancer survivors in community oncology.
Authors: Weaver Kathryn E. , Dressler Emily Van Meter , Lee Simon Craddock , Foraker Randi E , Smith Sydney , Klepin Heidi D. , Wells Brian J , Throckmorton Alyssa , DeMari Joseph , Nightingale Chandylen L 
Published: October 2024

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Background:
The Automated Heart-Health Assessment study (AH-HA: WF-1804CD, NCT# 03935282) evaluated the utility of a novel electronic health record (EHR) clinical decision support tool based on the American Heart Association Simple 7 cardiovascular health (CVH) factors to promote provider-patient CVH discussions in outpatient oncology. Before proceeding to future implementation trials, it is critical to establish the acceptability of the tool among patients and providers.
Methods:
Tool acceptability was assessed within a clinic-randomized trial (R01CA226078), coordinated by the Wake Forest NCORP Research Base (UG1CA189824), which randomized NCORP oncology practices using the Epic EHR to the AH-HA tool or usual care and enrolled survivors receiving routine care at least 6 months post-curative cancer treatment. The tool rendered an interactive display of risk factors, automatically populated from the EHR, alongside a tab indicating receipt of cancer treatments with cardiotoxic potential. Providers at AH-HA practices provided data after completing AH-HA training (6 items, 1-7 scale) and after 30 patients were enrolled (6 items, 1-7 scale). Survivors in AH-HA practices completed an acceptability assessment immediately following their routine visit (5 items, 1-5 scale). Descriptive statistics were quantified with mean and frequency for provider and survivor assessments: higher scores were associated with more positive ratings and the middle score was neutral.
Results:
Providers at 4 AH-HA practices (N=15, 8 MD/DO & 7 NP/PA) enrolled 296 survivors; of these 245 reported seeing or talking about the tool with their provider and comprised the analytic sample. The majority had breast cancer (93.9%). Most survivors were female with median time since diagnosis of 3.6 years (78.8% white/non-Hispanic, 13.1% Black; 5.3% Hispanic). 93-94% of survivors agreed: they liked the tool, it was helpful, and easy to understand; 85% would like to use the tool at a future appointment. Providers were largely satisfied with the training and felt prepared to use the tool with patients (scale mean (SD), range: 5.80 (0.97), 2–7).
Conclusions:
The AH-HA tool was acceptable to both patients and providers when used to promote CVH discussions during follow-up care for survivors. These data, coupled with data demonstrating the effectiveness of this tool at promoting CVH discussions during routine survivorship care, suggest future studies should focus on implementing AH-HA in community oncology. Qualitative data analyses in progress may elucidate priorities for future enhancements.
Clinical trial information: NCT03935282
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Provider Satisfaction with AH-HA Tool (N=15)
Mean (SD)

Provides useful information
5.93 (1.16)

Helps me be more effective
5.33 (1.63)

Makes information easier to access
4.87 (1.77)

Meets my needs when providing survivorship care
5.27 (1.49)

Easy to use
5.60 (1.24)

Useful format
5.93 (1.07)