MAPPP vs CV Risk Estimation

Despite the considerable efficacy of antithrombotics and the increased number of oral anticoagulants now available, preventable bleeding and thrombotic events are still unacceptably common. While recently marketed agents require less laboratory monitoring, problems with the clinical management of anticoagulated patients persist, particularly in the peri-procedural period. Surgery and invasive medical interventions increase the risk of bleeding, while withholding anticoagulants increases the risk of thrombosis due to the underlying condition(s) for which anticoagulation was originally prescribed. The clinical team must therefore balance these competing risks and make educated decisions regarding the decision to interrupt oral anticoagulation for a medical procedure and, if interrupted, whether to "bridge" anticoagulation with injectable anticoagulants, such as low molecular weight heparin (LMWH) in warfarin treated patients. This guide is intended to: -Assist clinicians in the simultaneous evaluation of procedure-related bleeding risk and underlying risk of thrombosis -Guide decisions regarding the interruption of anticoagulation and the use of anticoagulant "bridging" -Provide detailed guidance for drug dosing and laboratory monitoring in the peri-procedural period -Encourage clear communication between clinicians involved in prescribing anticoagulants and performing invasive procedures This material was created by the multidisciplinary members of the Peri-Procedural Task Force of the New York State Anticoagulation Coalition and IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 10SOW-NY-AIM-7.3-14-01

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.