Low dose aspirin is recommended by clinicians as a preventive measure for patients who have already had a heart attack or stroke, but the risk of taking low-dose aspirin to prevent or delay a first heart attack or stroke is less clear, as the benefit for reducing the risk of cardiovascular disease (CVD) must be balanced with the increased risk of gastrointestinal or other bleeding. To help clinicians and patients make informed decisions about aspirin use, researchers at Brigham and Women's Hospital have developed a new, free, mobile app, "Aspirin-Guide" that calculates both the CVD risk score and the bleeding risk score for the individual patient, and helps clinicians decide which patients are appropriate candidates for the use of low-dose aspirin (75 to 81 mg daily).
"We developed the Aspirin-Guide app because we realized that weighing the risks and benefits of aspirin for individuals who have not had a heart attack or stroke is a complex process. The new mobile app enables individualized benefit to risk assessment in a matter of seconds while the patient is with the physician," said Samia Mora, MD, cardiologist at BWH.
In a commentary published in JAMA in the June 20 issue, and a review in JAMA Internal Medicine published on the same day, co-authors Mora, and JoAnn Manson, MD, cardiovascular epidemiologist and Chief of Preventive Medicine at BWH, review the evidence behind the use of aspirin to delay or prevent a first heart attack of stroke, and give examples of how the mobile app can help patients and clinicians including:
- calculates a 10-year cardiovascular disease risk score (heart disease and stroke) for the patient
- calculates a bleeding risk score based on the patient's individual risk factors
- uses evidence from the literature, together with the above scores, to compare the number needed to treat vs. the number needed to harm
- helps clinicians to implement current clinical guidelines for low-dose aspirin in primary prevention
- provides the ability to email a summary of the decision-making process to the patient and/or to the clinician for the patient's record.
"Aspirin-Guide is a user-friendly clinical decision support tool, that will facilitate informed and personalized decision-making about the use of aspirin in primary prevention of CVD. Patients should discuss the pros and cons of aspirin treatment with their healthcare provider," Manson said.
The free Aspirin-Guide mobile app, developed for iPhones and iPads with the assistance of computer programmer, Jeffrey Ames, is available at the Apple app store on June 20, 2016.