Review of the ACC’s Anticoag Evaluator for iPhone, iPad, & Android

While starting oral anticoagulants for patients with atrial fibrillation (AF) is completely intuitive for most healthcare professionals, for patients it can be quite a shock. First they hear that that they have a high stroke risk. Then we tell them we’re going to start a medicine that could make them bleed from their gut or into their head. Its not hard to imagine how the overall message could get lost in that discussion.

The American College of Cardiology (ACC) Anticoag Evaluator is an app designed to help clinicians with that discussion by giving them some specific numbers on stroke risk, bleeding risk, and effect of OAC therapy drawn from the pivotal trials behind these drugs.

The app opens to a screen where we can calculate the CHADS, CHADS2VASC, and HAS-BLED scores for our patient. Its important here to note that you have to tab over to the CHADS2VASC and HAS-BLED screens and enter data in each before moving on; if you just enter the CHADS2 variables on the first screen and then go forward, you’ll get inaccurate CHADS2VASC and HAS-BLED scores.

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When we move on by tapping the arrow on the bottom right of the screen, we are taken to a screen showing us a variety of strategies. Starting with the no therapy option, we can get our baseline risk levels for stroke annually.

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Then we go to our recommended therapy and can get information on risk reduction as well as bleeding risk. These risks and benefits are calculated based on the relative risk reductions and bleeding rates identified in the pertinent trials i.e. for apixaban, that information would come from ARISTOTLE. Here, I selected apixaban and can now discuss with my patient that the risk of stroke can be reduced by approximately 75% and that the risk of major bleeding is around 2.6%.

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Dosing information is also available in the Selected Therapy section. In the Guidelines and Resources section, we have links to resources like the ACC/AHA/HRS 2014 recommendations.

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The app is based on the Sparctool website created by Peter Loewen, Pharm D whose work includes a 2011 review of bleeding risk with the novel OACs”1”. The app appears to be well supported as well, with several updates since its release in 2013. The last update was in August 2014, however, and multiple users have reported problems with iOS 8 (this review was done with iOS 7). There’s also no information on how the app was tested for accuracy but we’re fairly reassured of the apps reliability given its authorship.

Its important to note that the app’s purpose is not to tell you what OAC to start. There are clearly other considerations when making that decision – age, dosing frequency, renal function, bleeding risk, and more. What it does help with is giving you more tools to explain the risks and benefits to your patient, making them a more active & informed participant in their medical care.

  • Price
    • Free
    • Design is set up to get you to the information you need with as few steps as possible
    • Reputable source with detailed methodology information both in the app and on the Sparctool website.
  • Dislikes

     

    • Lack of information on testing
    • Ability to fill out just one of the three risk scores before moving forward is flaw that should be fixed

     

  • Overall

    The ACC Anticoag Evaluator is a well designed app that repurposes data from clinical trials into a format that addresses a practical need – facilitating better communication and helping patients understand the importance and rationale behind this important therapy.

  • Overall Score
  • User Interface

    Some improvements could be me made to reduce chance of error but overall well designed

  • Multimedia Usage
    • N/A

    Less relevant for this apps intended use

  • Price

    Free

  • Real World Applicability

    Helps with a complex but importance discussions with patients

  • Device Used For Review

    iPhone 5S OS 7

  • Available for DownloadAndroidiPhoneiPad