Author + information
- Ty J. Gluckman, MD∗ (, )
- Richard J. Kovacs, MD,
- Neil J. Stone, MD,
- Dino Damalas, MBA,
- J. Brendan Mullen, BSFA and
- William J. Oetgen, MD, MBA
- ↵∗Providence Heart and Vascular Institute, 9205 SW Barnes Road, Portland, Oregon 97255
Initial incorporation of the 2013 Blood Cholesterol Guidelines (1) into clinical practice came with a particular challenge. Providers were asked to assess atherosclerotic cardiovascular disease (ASCVD) risk by manually entering data into an electronic spreadsheet, using the Omnibus Risk Estimator (2). Not only was this an impractical solution for nearly all providers at the point of care, it also severely limited patients’ ability to engage in risk assessment.
The solution was obvious, we needed a point-of-care tool that would allow providers the ability to easily calculate 10-year ASCVD risk, and although such a stand-alone tool would certainly be valuable, we recognized that this represented an opportunity to do so much more. This, in essence, is the history of the ASCVD risk estimator application software (app).
On February 10, 2014, the ASCVD risk estimator was made available for free by the American College of Cardiology and American Heart Association, both on the internet and as an app on iTunes and Google Play (Figure 1). To date, there have been >3.9 million internet/app visits and over 240,000 app downloads. On average, it is used >11,000 times each day.
Although the app has received positive feedback, including being rated the best medical app by MedPage in 2014 (3), there is room for improvement. Most pressing for us is a desire to better inform individuals that a predicted ASCVD risk of ≥7.5% should not automatically lead to a statin prescription. Often misunderstood, the guideline actually recommends that these primary prevention patients first enter into a dialogue with their clinician about: 1) the anticipated benefits and potential adverse effects associated with statin therapy; 2) the risk of drug-drug interactions; 3) the importance of addressing other risk factors; and 4) inclusion of an informed patient’s preference. This clinician-patient risk discussion is an important first step in patient engagement and can be a powerful aid to improve not only medical decision making but, if a statin is chosen, medication adherence.
It is for these reasons that the app was recently highlighted as an effective tool to implement shared decision making (4). Simply put, the app is a decision aid that can be used by patients and care providers, either together during the clinical encounter or separately between visits. Used appropriately, this app empowers more patients to know their risk and more care providers to discuss what can be done to improve it.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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- ↵Omnibus Risk Estimator. Available at: http://static.heart.org/ahamah/risk/Omnibus_Risk_Estimator.xls. Accessed September 3, 2015.
- ↵Best medical apps released in 2014. iMedical Apps, MedPage Today. Available at: http://www.imedicalapps.com/2014/12/best-medical-apps-released-2014/12/. Accessed June 20, 2015.
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