Cardiovascular disease (CVD) is number 1 cause of death globally, killing more people than all forms of cancer combined. In the U.S., there were 87,000 deaths from cardiovascular disease (CVD) in 2015. Evidence has shown that CVD can be prevented by taking low doses of aspirin - widely available and well-known pain relief – on a daily basis. This evidence is established for secondary prevention of CVD, while the evidence for using the aspirin for primary prevention is still controversial.
Prescribing aspirin is difficult and complicated process, and healthcare providers are often solely responsible for the decision whether their patient is eligible to use aspirin for the prevention of cardiovascular disease. This decision requires assessment whether the benefits of taking low-dose (about 75 to 80 mg) aspirin outweigh the risks for each patient. The potential risks are hemorrhagic stroke and gastrointestinal bleeding, which are the primary concerns of using aspirin for primary prevention.
The United States Preventive Services Task Force (USPSTF) published their recommendation statement on the use of aspirin for the primary prevention of cardiovascular disease and colorectal cancer. These recommendations use Grade system, with three different grades that cover patients of different age.
For example, Grade "B" gives recommendations for 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.
"Grade C" recommendation is for adults aged 60-69 and "Grade I", which stands for 'insufficient evidence' is for adults younger than 50 years and adults over age 70.
While these recommendations are certainly useful, they still require providers to use different medical calculators to combine the results, which is still confusing and cumbersome process.
Having a mobile medical app that could do these multiple calculations and collect the data for use at the point of care would be a much better solution for both healthcare providers and their patients.
This is why researchers at Brigham and Women's Hospital and Harvard Medical School, created a free medical app for Android and iOS devices called Aspirin Guide with the aim to help clinicians decide which patients are ideal candidates for the use of low dose aspirin in the primary prevention of cardiovascular disease (CVD).
The Aspirin Guide app gathers patient's risk information to calculate a 10-year risk of cardiovascular disease using the ACC/AHA ASCVD score calculator. It also calculates a bleeding risk score using the most recent evidence on aspirin use and bleeding, helping clinicians derive benefits and risks of aspirin therapy for their patients.
For the purpose of this review, we used the non-specific case of 48-year old black male, who falls under Grade "I" of USPSTF recommendations, i.e. without sufficient evidence about potential benefits or harms.
Still, the patient's smoking habit and his medical history of vascular disease, hypertension and hyperlipidemia, put him at risk of CVD and make him a good candidate for a low dose aspirin use. The patient also has chronic indigestion that should be considered before starting therapy. That's why we wanted to use this app to calculate the risks and benefits of aspirin use in this patient.
As you could see, the Aspirin Guide is a calculator with simple and straightforward interface that takes you through the set of questions, intended to help you make the best possible decision regarding aspirin use.
Beside standard questions regarding your patient's age, sex and ethnicity, you'll be asked to enter other relevant data about patient's smoking habits, blood pressure and cholesterol levels, blood pressure drugs (if they use any) or other medications, such as NSAIDs, corticosteroids, cholesterol-lowering drugs or antithrombotic agents. You'll be asked if your patient has other conditions, such as diabetes, atrial fibrillation or GI disorders that should be considered before aspirin use.
The navigation through the calculator is very easy. The app allows you to return to previous pages using the Back button, if you need to correct the entries.
Once you've finished with entering all the data, you'll get the summary of your patient that you need to confirm in order to proceed to the results.
The results are concise, showing recommendation on whether your patient should start the low dose aspirin, along with the ASCVD (atherosclerotic cardiovascular disease) and bleeding risk scores, and 10-year NNT and NNH numbers, where NNT should be less than NNH, i.e. benefit greater than harm.
Based on our patient information we got lower NNT score, meaning that the benefits of low aspirin use outweigh the risks.
You can share these results with you patient via email, or restart the algorithm to start entering the information for other patient.
Aspirin Guide is an app that every primary care provider or anyone who prescribes aspirin to patients for primary prevention of cardiovascular disease should have. It's simple, but effective tool that makes difficult and complicated decisions much easier.
Benefit: Any medical provider who may prescribe aspirin for primary prevention of CVD.