Given the increasing average age of the patients in the US, coupled with the associated co-morbid conditions that these patients have, it is important to have a quick and easy tool to be able to assess risks involved with starting a new treatment plan or drug.
This is very much the case in patients with atrial fibrillation. Most of these patients will probably have a high enough CHADs2 score to warrant oral anticoagulation to reduce the risk of possible future stroke.
The quandary most physicians face in this situation, is the potential risk for bleeding in these most often elderly complicated patients.
In March, 2010 the Euro Heart Survey was published in Chest. The outcome of this study was a simple user-friendly calculator to help assess the one year risk of major bleeding in patients with atrial fibrillation on oral anticoagulants.
HAS-BLED which is an acronym for (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly (>65 years), Drugs/alcohol concomitantly) was calculated based on risk factors derived from the cohort of patients enrolled in this study.
The app has a very simple layout.
There are three tabs at the bottom of the screen, Risk Factors, Results and Info. On launching the app, the user is presented with the calculator which consists of Yes/No answers to each component which is on the first tab. The second tab gives the user the bleeding risk results.
The results are shown as the HAS-BLED score and as a percentage of the bleeding risk per year. The Info tab provides a disclaimer and information about the clinical content provider and reference to the study in Chest. While the screens of the iPhone and iPad are similar, it is worth noting that the screenshots of the iPad version provide the calculated risk on the same page.
Navigation is very simple as there are only three tabs to navigate and not much else.
Given how simple the app is, the user experience is very limited. It serves the purpose of being a quick bleeding risk calculator in that it takes very little time to obtain the bleeding risk for the patient and allows the physician to quickly use the information in the decision making process.
- Very simple and easy to use
- No universal app for iPhone and iPad
- Previously entered values need to be manually cleared every time app is used
- The app may find it’s place with physicians as they try to determine the bleeding risk in patients with atrial fibrillation who qualify for oral anticoagulation therapy
- Of note, the same calculator is available for free on the internet with a simple search. On the iPhone you can save a website to your home screen which will allow you to access the free calculator virtually any time (caveat to this is having a reliable cellular or wifi signal).
- We recommend physicians look at the web version of the calculator, and decide for themselves if the $3.99 is worth it for a stand alone app.