Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital. I would like to talk with you about two new publications[1,2] and a free mobile app called Aspirin Guide, which provide resources for clinicians to help with decision-making about the use of low-dose aspirin in primary prevention of cardiovascular disease (CVD). My colleague, Dr Samia Mora, and I were interested in doing an updated review of the randomized clinical trials of aspirin in the primary prevention of CVD (overall, there is about at 15% reduction) and also in providing a clinical support tool that would help clinicians to implement current guidelines about the use of low-dose aspirin (75-81 mg daily) in the primary prevention of CVD. We were fortunate to be able to work with an experienced programmer and mobile app developer, Jeffrey Ames, to design Aspirin Guide, which is available for iPhone and iPad and which has an internal risk calculator—the American Heart Association/American College of Cardiology 10-year risk score—as well as a bleeding risk score to help clinicians make careful and individualized decisions about the use of low-dose aspirin in the primary prevention of CVD.
The US Preventive Services Task Force has recently provided guidelines for the use of aspirin in primary prevention, and they gave a "B" recommendation, which is generally advised for men and women ages 50-59 if they have a high CVD risk (a 10-year CVD risk score of ≥ 10%) and no excess risk of bleeding. They gave a "C"-level recommendation, which is a lower-level recommendation, but consider and individualize the recommendation for men and women ages 60-69 who have a high CVD risk (at least 10% over 10 years) and no excess risk of bleeding. The problem is that it's difficult to implement these guidelines without having a clinical decision-support tool that does the parallel assessment of CVD risk and bleeding risk.
Our review of the randomized trials of aspirin in primary prevention was published in JAMA Internal Medicine, and concurrently we published in JAMA a viewpoint article that provides several clinical scenarios for using this clinical support tool for making decisions about the use of low-dose aspirin in primary prevention of CVD.
The mobile app Aspirin Guide also incorporates some sex-specific guidelines, such as the randomized clinical trials and earlier guidelines that recommended that even women at moderate risk who were age 65 or older, if they didn't have excess risk of bleeding, could also be considered candidates for low-dose aspirin therapy, so we incorporate these sex-specific guidelines into the decision-support tool and mobile app. We also have a note of caution for patients in the public to be under the care of their healthcare provider and be supervised in making decisions about long-term aspirin therapy in the primary prevention of CVD.
So, although in secondary prevention the use of aspirin is often a straightforward decision, in primary prevention it can be quite complex. We hope that the Aspirin Guide app and these two papers will help clinicians make more informed and personalized decisions about the use of low-dose aspirin in primary prevention of CVD and to have shared decision-making with their patients. Thank you so much for your attention. This is JoAnn Manson.
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Cite this: Who Should Take Low-Dose Aspirin? This App Can Help You Decide - Medscape - Jun 27, 2016.