Knowledge translation and patient engagement

In Cardiology clinic last week, I met a man who was being followed post-STEMI and angioplasty, with his last event occurring in 2017. He was feeling well, and happy with his course over the past year and a half - following this, the question du jour became what to do with his dual antiplatelet therapy (DAPT). 

On review with my staff, we discussed the most recent set of recommendations from the Canadian Cardiovascular Society (https://www.onlinecjc.ca/article/S0828-282X(17)31221-7/pdf) for post-PCI DAPT, and felt satisfied with this patient's course thus far, particularly his absence of ischemic or bleeding events, and ability to tolerate his medications. We now asked ourselves, what was the utility in continuing his Clopidogrel for another 6 months? Another year?

There isn't a hard and fast answer to this question, but there are tools that help with decision-making around DAPT, to which my staff introduced me that afternoon.

The DAPT Online Calculator (http://tools.acc.org/DAPTriskapp/#!/content/calculator/), hosted by the American College of Cardiology, can be used to help guide conversations around DAPT, specifically as it relates to ischemic and bleeding risks, based on a patient's unique risk profile.

It also includes a section that specifically compares the rates of events upon cessation of therapy at 12 months (generally the minimum duration of treatment post-PCI) vs. continued treatment.

Of note, this calculator is intended for use in patients who had been on 12 months of DAPT therapy, without any ischemic or hemorrhagic events during the treatment period - importantly, this reflected the patient we were seeing in clinic that afternoon.

There are a few advantages to using this calculator as an adjunct to assessment and planning. For one, it helps guide trainees and staff through conversations about relevant cardiovascular risk factors, DAPT treatment complications, and treatment utility, which serves as a great learning tool.

It also produces data in a very clear and simple fashion, serving as a bridge to facilitate more open and accessible conversations between the care team and the patient themselves; when taken advantage of, this can promote patient-centred care. 

I look forward to having more opportunities on the Cardiology service to further develop my own knowledge around treatment and risk prevention in ACS, and capitalize on emerging tools (like this calculator) to help facilitate clear communication and support patient engagement in my practice.