Acute coronary syndromes (ACS), encompassing ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA) represent commonly encountered events, and often require prompt diagnosis and management strategies to prevent associated morbidity and mortality.
Fortunately for physicians and patients, an abundance of outstanding, well-conducted clinical trials have guided appropriate, evidence-based recommendations to aid the management of patients with ACS.
However, this abundance of clinical trials can also make it difficult for healthcare providers to keep the conclusions and caveats of each trial straight.
This interesting challenge is well-known to pretty much every physician and medical student. As a result, a few entrepreneurial people at Washington University in Saint Louis/Barnes-Jewish Hospital decided to do something about it.
Dr. Jason Meyers, a first-year cardiology fellow, and Drs. Michael Nassif, Prashant Atri, and David Suk, third-year internal medicine residents, developed the ACS Trials App.
Here we talk to them to learn how a group of physicians recognized a need and came up with a solution.
AP: What served as your inspiration for the ACS Trials App?
MN: In this age of evidence-based medicine, it seems to happen all too often, especially as a trainee, that you know there is evidence for one therapy over another, but you can’t remember where that evidence came from, the dose studied, and so on. This app is designed so that when you’re at the bedside or on rounds, you can quickly and easily access that information.
AP: What’s a quick description of what the ACS Trials app offers?
MN: ACS Trials brings you thorough, focused, MD-written summaries of the seminal trials of acute coronary syndromes (ACS) that have given rise to current practice. Its easy-to-use interface and layout provide quick, accessible, one-line ‘soundbites’, as well as deeper analysis and historical context of landmark trials in cardiology.
Trials are sortable by name, date of publication, and subject; can be filtered by ACS subtype (NSTEMI or STEMI); and are discoverable via a convenient search feature which indexes keywords, generic drug names, brand names, and more. Each trial includes a take-home message, summary, design, baseline characteristics, and results, as well as the relevant ACC/AHA guidelines.
AP: For what target audience did you design the app?
JM: ACS Trials has a broad target audience. A pharmacist needing to know the bivalirudin dosing regimen in the ACUITY trial, a medical student whose attending is asking “What’s the evidence for aspirin?”, a nurse practitioner wondering why they should continue the eptifibatide drip when the stent is already in place, a resident wondering how long after ACS was atorvastatin started in PROVE IT-TIMI 22, a cardiology fellow who can’t remember the loading dose of ticagrelor, or a cath fellow making sure they’re right about bivalirudin before the interventionalist yells at them.
AP: How did you choose which trials to include in the app?
JM: We utilized Dr. Richard Bach, who is an interventional cardiologist and director of the Cardiac Intensive Care Unit (CCU) at Washington University in Saint Louis. He has a unique knowledge of, and affinity for, evidenced-based medicine. Our goal was to include both the landmark trials that built the foundation for ACS management, as well as modern trials that will likely be shaping future therapies.
As such, we included everything from the aspirin studies of the early 1980s, to the studies of rivaroxaban after ACS released in last week’s New England Journal of Medicine (NEJM). Because ACS trials was created by a cardiology fellow and three internal medicine residents at Washington University in St. Louis who are passionate about cardiology and evidence-based medicine, our customers can expect frequent updates as more landmark trials become available and as guidelines change to encompass these seminal trials.
AP: How did you build the content that’s contained in the app?
MN: With the help of our partners Prashant Atri and David Suk, we took the information directly from trial manuscripts. We meticulously reviewed them for accuracy, and included a summary to give some context as to why the trial was pertinent to the way ACS is treated.
AP: What features make the ACS Trials app unique?
JM: I think our search function will really facilitate finding evidence quickly. For instance, if you are curious why someone is on prasugrel you can simply enter the search term “prasugrel.” It will then bring up the TRITON study which compared prasugrel and clopidogrel, and the user can decide which is the ideal treatment.
AP: How do you plan to price the ACS Trials App?
JM: ACS Trials will be available through the Medical category of the App Store for $2.99. A free lite version, with a limited number of trials but the full complement of medical calculators, will also be available.
We thank Drs. Nassif and Meyers for their time and look forward to the debut of the ACS Trials App. We will bring our readers a full app review soon.