Aspirin guide app launched that aid physicians in clinical decision making: Who should be put on low dose aspirin?

The Aspirin Guide app

The beneficial role of  low dose aspirin for secondary  prevention of cardiovascular event and stroke after a primary event is backed by large clinical trial data, reviews and meta-analysis.

Physicians face a more challenging question in clinical practice- who should be put on daily low dose aspirin to prevent first cardiovascular event or stroke so that the benefits outweigh the risks of GI bleeding.

The US Preventive Services Task Force (USPSTF) recently issued clinical guidelines for use of  aspirin as preventive medication. It advises  “initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years 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 low-dose aspirin daily for at least 10 years ” with a recommendation ‘B’.

The decision to start aspirin for men and women aged 60-69 who have a 10% or greater 10-year CVD risk is individualized according to each patient and it received a lower level ‘C’ recommendation.

But, Physicians find it’s very time consuming to implement and requires them to  make two different calculation. First they have to calculate the CVD and stroke risk and then refer a table that  gives you the bleeding risk.

 Brigham and Women’s Hospital, Harvard Medical School has launched an app named ‘aspirin guide’ which helps physician decide that which patient can be safely started on low dose aspirin balancing the risks and benefits.

The app comes with several unique features including:

It has the US Preventive Services Task Force recent guidelines for the use of aspirin for. primary prevention.

It calculates a 10 year cardiovascular disease risk score based on series of inputs the physician provides about patient’s medical statistics. Based on the score and the bleeding risk, the app can aid in decision making in prescribing aspirin.

The summary of decision making can be mailed to the physician and patient.

It also have sex specific guidelines incorporated, so that according to the earlier  guidelines  and RCTs even women  65 and older can be put on therapy if they are not at high risk for GI bleeding.

The app also have an algorithm flow chart for shared decision making that can be easily followed.

The app is developed by  Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital, Dr. Samia Mora, MD, MPH is a cardiologist and cardiovascular epidemiologist and Jeffery  Manson is a computer programmer who develops  medical  apps.

Reference:

https://itunes.apple.com/nz/app/aspirin-guide/id1117434628?mt=8

http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/aspirin-to-prevent-cardiovascular-disease-and-cancer

Bibbins-Domingo K, on behalf of the U.S. Preventive Services Task Force. Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2016;164:836-845. doi:10.7326/M16-0577