DAPT Risk Calculator vs CV Risk Estimation

The ACC DAPT Risk Calculator provides clinical decision support for clinicians evaluating the continuation of DAPT therapy for patients at least 12 months post-PCI procedure, and the risk/benefit of continuing or discontinuing DAPT. The App provides a DAPT Risk Score as a numerical value between -2 and +9, where a Higher DAPT scores suggest that the benefit/risk ratio with prolonged DAPT may be favorable. Conversely, lower DAPT scores suggest that the benefit/risk ratio with prolonged DAPT is NOT favorable. The clinical decision support tool also calculates the percentage of risk for three end points: - Myocardial infarction (MI) - Stent thrombosis, major adverse cardiovascular and cerebrovascular events (MACCE) - Bleeding

This app is for CLINICIANS, not the lay public. The CV Risk app presents clinicians with three valuable 10-year cardiovascular event risk calculators to serve clinicians and learners in primary prevention of cardiovascular disease. It is for clinicians only, not the lay public. The calculators are Framingham 2008, ASCVD 2013, and the revised pooled cohort equations ASCVD of 2018. The app addresses such common questions as: • What is the ASCVD 10-year CV risk for a 57 year old male hypertensive smoker with a given set of lipid and blood pressure numbers? • What’s the magnitude of impact of a patient on their own improving their cholesterol by 11, 27, or 41 points? • For a poorly controlled hypertensive smoker with a 10-year risk of 31.3%, how impactful would improved blood pressure control or smoking cessation be? • How impactful is a cholesterol of 220 on a given patient's risk at 35 vs. 55 vs. 75 years old? • I hear that ASCVD 2013 overestimates risk, particularly for black adults? True? What about the revised pooled cohort equations of 2018? The app explicitly does not include treatment thresholds, LDL targets, estimates of impact of therapy, coronary calcium scoring, etc. I wanted the cleanest simplest tool possible for evaluating and discussing cardiovascular risk with all the other more subjective, controversial stuff out of the way. This app is written and intended for practicing clinicians like internists and family physicians; for resident physician trainees; for medical students; and of course for other clinician colleagues like NP's and PA's. Cardiologists could use this app, but you folks are focused on secondary prevention, which is an entirely different ballgame. As an educator and clinician, I am interested in feedback and I would be grateful for guidance on improving the tool.