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A Web-Based Application for Risk Stratification and Optimization in Patients With Cardiovascular Disease: Pilot Study
Avinash Pandey1,2, Marie Michelle D'Souza2, Amritanshu Shekhar Pandey2,3
1Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Insights
The Stratification and Optimization in Patients With Cardiovascular Disease (STOP-CVD) application is a feasible and usable tool for improving secondary prevention therapy uptake in cardiovascular disease patients, showing high clinician satisfaction.
Area of Science:
- Cardiology
- Digital Health
- Clinical Informatics
Background:
- Novel therapies improve outcomes in atherosclerotic cardiovascular disease (ASCVD) but face challenges in uptake.
- Knowledge translation strategies are needed to enhance secondary prevention therapy adoption.
- Individualized risk stratification and guidance can support guideline-directed therapy.
Purpose of the Study:
- To test the feasibility and usability of the Stratification and Optimization in Patients With Cardiovascular Disease (STOP-CVD) application.
- To evaluate STOP-CVD's role in facilitating knowledge translation for secondary prevention.
- To assess clinician experience with a point-of-care risk stratification and optimization tool.
Main Methods:
- A free, web-based secondary risk calculator was developed using the REACH Registry trial data (67,888 patients).
- The application predicted 20-month cardiovascular event/mortality risk and identified modifiable residual risk.
- Physicians received invitations; user experience surveys and Google Analytics data were collected postimplementation.
Main Results:
- During a 1-year pilot, 47 of 240 invited clinicians used the STOP-CVD application 1573 times.
- Sustained usage averaged 131 uses per month.
- All 24 survey respondents found the application functional, easy to use, and useful.
Conclusions:
- The STOP-CVD application demonstrates feasibility, usability, and high clinician satisfaction.
- This tool can be scaled to support guideline-directed medical therapy uptake.
- Future research will assess the impact on clinical management and patient outcomes.
Background:
In addition to aspirin, angiotensin-converting enzyme inhibitors, statins, and lifestyle modification interventions, novel pharmacological agents have been shown to reduce morbidity and mortality in atherosclerotic cardiovascular disease patients, including new antithrombotics, antihyperglycemics, and lipid-modulating therapies. Despite their benefits, the uptake of these guideline-directed therapies remains a challenge. There is a need to develop strategies to support knowledge translation for the uptake of secondary prevention therapies.
Objective:
The goal of this study was to test the feasibility and usability of Stratification and Optimization in Patients With Cardiovascular Disease (STOP-CVD), a point-of-care application that was designed to facilitate knowledge translation by providing individualized risk stratification and optimization guidance.
Methods:
Using the REACH (Reduction of Atherothrombosis for Continued Health) Registry trial and predictive modeling (which included 67,888 patients), we designed a free web-based secondary risk calculator. Based on demographic and comorbidity profiles, the application was used to predict an individual's 20-month risk of cardiovascular events and cardiovascular mortality and provides a comparison to an age-matched control with an optimized cardiovascular risk profile to illustrate the modifiable residual risk. Additionally, the application used the patient's risk profile to provide specific guidance for possible therapeutic interventions based on a novel algorithm. During an initial 3-month adoption phase, 1-time invitations were sent through email and telephone to 240 physicians that refer to a regional cardiovascular clinic. After 3 months, a survey of user experience was sent to all users. Following this, no further marketing of the application was performed. Google Analytics was collected postimplementation from January 2021 to December 2021. These were used to tabulate the total number of distinct users and the total number of monthly uses of the application.
Results:
During the 1-year pilot, 47 of the 240 invited clinicians used the application 1573 times, an average of 131 times per month, with sustained usage over time. All 24 postimplementation survey respondents confirmed that the application was functional, easy to use, and useful.
Conclusions:
This pilot suggests that the STOP-CVD application is feasible and usable, with high clinician satisfaction. This tool can be easily scaled to support the uptake of guideline-directed medical therapy, which could improve clinical outcomes. Future research will be focused on evaluating the impact of this tool on clinician management and patient outcomes.
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