There were 86,641 deaths from cardiovascular disease (CVD) in the US in 2015. CVD kills more people than ALL forms of cancer combined. The evidence base is firmly established for secondary prevention of CVD with multiple medications including aspirin, and statins. The evidence for primary prevention for aspirin is somewhat more controversial, but nonetheless compelling.
The primary concerns of using aspirin for primary prevention are the potential risks of hemorrhagic stroke and gastrointestinal bleeding. The United States Preventive Services Task Force (USPSTF) updated their recommendation statement on the use of aspirin in 2016.
Their new statement gives a “Grade B” recommendation for the use of aspirin for the primary prevention of cardiovascular disease and colorectal cancer in adults aged 50-59 who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take aspirin for at least 10 years.
The USPSTF gave a “Grade C” recommendation for adults aged 60-69 and a “Grade I” recommendation for adults over age 70. It doesn’t take a rocket scientist to see how this seemingly simply recommendation can completely confound primary care providers. The USPSTF just asked us to use at least 3 different medical calculators and combine and explain the results to patients in a 20 minute appointment — and this is just for aspirin use!
Clearly, providers and patients could benefit from a medical app that could do these multiple calculations and collate the data for use at the point of care. Enter Dr Samia Mora, MD, MPH, Dr JoAnn Manson, MD, DrPH, and Mr Jeffrey Ames, BS, MEng from Brigham and Women’s Hospital and Harvard Medical School who created the fabulous new app, Aspirin Guide. The Aspirin Guide medical app calculates a patient’s risk of cardiovascular disease using the AHA/ACC pooled equations calculator, a bleeding risk score using the most current evidence on bleeding and aspirin use to derive a patient’s likely benefits and risks of aspirin therapy.
Let’s use a case to demonstrate the utility of the new Aspirin Guide app. You are in clinic evaluating a 64 year old black male non-smoker, without known ASCVD with a history of hypertension, hyperlipidemia, Type II diabetes who has a history of peptic ulcer disease due to NSAID use for osteoarthritis. What are the risks and benefits of aspirin use in this patient?
Video Review of Aspirin Guide
Evidence based medicine
The evidence behind the aspirin app is robust and backed by the systematic review conducted by the USPSTF, the data synthesis used by the ACC/AHA to create the ASCVD risk calculator and the multitude of studies that have evaluated bleeding risk in aspirin users. The authors of the app have taken all of this information and created an easy to use app to help providers determine which patients may benefit from the use of aspirin. The app uses evidence-derived statistics such as the number needed to treat (NNT) and number needed to harm (NNH) to aid in shared decision making.
Who would benefit from the Aspirin Guide app?
Students, nurses, residents, mid-levels, primary care or any specialty medical provider who may prescribe aspirin to patients/apply the USPSTF guideline on aspirin for primary prevention.
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
- Simple to use interface with easy data input and includes graphic of algorithm.
- Fantastic explanation of results including patient friendly statistics.
- Contains links to references and the USPSTF guideline.
- Does not contain links to author’s other recently published articles on the topic.
- Only CV risk calculator option is the ACC/AHA ASCVD risk score.
- Not available for Android at this time.
The Aspirin Guide app is truly a contender for medical app of the year. The medical app takes the best available aspirin evidence and allows physicians to “make sense” of the current USPSTF guideline on use of aspirin for primary prevention. Aspirin Guide is a pleasure to use and the data output is easily understood by both provider and patient alike.
- Overall Score
- User Interface
Easy to use interface, with quick data input with outstanding data output in easy to apply, and explain, statistics. The app also includes numerous resources that are easy to access within the app.
- Multimedia Usage
App has links to the USPSTF aspirin recommendation statement as well as built in calculators to assess a patient’s risk of a CV event and the potential benefits and harms of aspirin. The app includes a great graphic of the overall algorithm used to make aspirin recommendations.
App is free!
- Real World Applicability
Aspirin Guide is a must have app for anyone who prescribes aspirin to patients for primary prevention of cardiovascular disease. The app presents the data using proper health statistics that can be used for shared-decision making at the point of care. The app operationalizes the current USPSTF guideline on aspirin to make the process “simple” for providers to ensure patients who could truly benefit from aspirin get it, while balancing the risks of harm. This is an app that every primary care provider and many others could use daily to make the point of care decision more efficient and evidence-based.
- Device Used For Review
iPhone 6S running iOS 9.3.1
- Available for DownloadiPhoneiPad