Risk factors

CSANZ 2022: Smartphone app reduces CVD risk factors


Reducing cardiovascular risk factors in women with breast cancer is feasible and effective using smartphone technology, an Aussie researcher says.

Dr Alexandra Murphy, a cardiologist and finalist in the prestigious Ralph Reader Prize (Clinical) at CSANZ 2022, told the meeting that many women were affected by both conditions.

“With advancements in modern breast cancer therapy, we are now seeing increasingly higher rates of cure and over time, cardiovascular disease becomes the leading cause of death in breast cancer survivors.”

Dr Murphy, currently on a Fulbright Scholarship at Mt Sinai Hospital in New York, presented research carried out in her previous position at Austin Health.

“When considering the burden and significance of cardiovascular disease in breast cancer patients, our group retrospectively analysed over 1,000 women who presented for treatment at our institution over a 10 year period.”

“From this cohort, we developed the novel Cardiovascular Risk Index in Breast Cancer (CRIB) to estimate the risk of MACE.”

The study found a CRIB score of 3 or more, which represented 23.9% or nearly a quarter of the cohort, was associated with a high risk of MACE. Women who experienced a MACE had an almost three-fold risk of death.

“As such, attention to reducing the cardiovascular risk, must be a priority in the management of these women. Of all lifestyle interventions, physical activity has the most robust effect on outcomes and confers a survival benefit on both cardiovascular disease as well as breast cancer.”

“Despite this, most breast cancer patients when experiencing treatment following their diagnosis have a significant decline in the exercise levels, in part due to a lack of broad-reaching, convenient and cost effective programs.”

Dr Murphy said a systematic review and meta-analysis of the evidence confirmed the feasibility of mobile health technology in reducing cardiovascular risk factors, such as physical activity, in breast cancer survivors.

Given the limited program options available, she developed BreastMate — a smartphone app for breast cancer patients.

“In short, it is a novel multifaceted program incorporating all aspects of cardiovascular risk mitigation and utilises the self-efficacy theory to engage and empower women.”

“By linking to the smart phones’ internal accelerometer, users have real time feedback on their activity level,” she said.

The app also allows women to store and share their data with clinicians “and improves communication between the many healthcare providers they now have”.

The app was compared against standard care in an RCT of 103 women undergoing treatment for early breast cancer across four sites in Victoria. The primary outcome was functional exercise capacity using the validated 6-minute walk test (6MWT) distance at 12 months compared to baseline.

“In keeping with our primary hypothesis, patients enrolled in the BreastMate arm demonstrated a statistically and clinically significant improvement in exercise capacity, with an improvement in the 6MWT distance of 46 m compared to only 8 m in the standard of care group.”

“This demonstrates a five-fold improvement in exercise capacity with BreastMate.”

Dr Murphy said the RCT also found patients in the BreastMate group had a 1 cm reduction in waist circumference and a 5 mmHg reduction in systolic blood pressure. There was also a significant improvement in the patient-reported vitality domain of the quality of life measure but no difference in other secondary outcomes.

“This is the first RCT which assesses a holistic cardiovascular risk reduction program in breast cancer patients. We have met the primary endpoint by demonstrating that BreastMate successfully improved exercise capacity in women.”

“In a post-pandemic era of social isolation and reallocation of hospital resources, smart phone and digital health platforms such as BreastMate are particularly powerful.”

A larger scale trial of the app is currently underway at Mt Sinai, adequately powered for the secondary outcomes and with analysis of long-term consumer engagement.

She told the limbic that longer follow-up will determine if benefits sustained at 12 months can be continued.

“With a bigger study with many more women … I will be really interested to see measures like lipid levels and statin use, because we know that there is some involvement with cholesterol metabolism and breast cancer that hasn’t really been extrapolated well yet.”

“I think that will be really interesting and we also have to remember that systemic hypertension is an extremely important risk factor and particularly in breast cancer patients in terms of latent cardiotoxicity.”

“I see exercise as a synergistic treatment for cancer therapy. This doesn’t replace chemotherapy, it doesn’t replace radiotherapy, but should sit alongside.”

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