Aspirin Guide app review, makes sense of evidence based USPSTF recommendations

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.