Streamlining Statin Intolerance
Information The ACC’s Statin Intolerance App
Health Tech | We previously had the opportunity to review two clinical decision support apps released by the American College of Cardiology: The Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator, and the Clinical Guidelines app. Building upon the success of these apps, the ACC recently released an app dedicated to helping clinicians evaluate statin intolerance.
A recent article in Circulation1 explains that statin intolerance occurs when “a patient is unable to continue to use a statin, either because the development of a side effect or because of evidence on a blood test that certain markers of liver function or muscle function (creatinine kinase) are sufficiently abnormal to cause concern. The intolerance can be either partial (i.e., only some statins at some doses) or complete (i.e., all statins at any dose).” Myalgias are the most common presenting symptom of statin intolerance, and can occur in up to 15% of treated patients. While these are generally mild and reversible upon cessation of statin therapy, in extremely rare cases, statin intolerance can lead to rhabdomyolysis.
Given the importance of statin therapy to the reduction of cardiovascular disease, it is critical that cardiologists know how to recognize, evaluate, and manage statin intolerance in their patients. We had the opportunity to review the ACC’s Statin Intolerance app, which aims to facilitate the clinician-patient discussions about possible statin-related myalgias and other symptoms. The ultimate goal is to help manage these issues so that the patient can stay on statin therapy when appropriate.
Derived from the 2013 ACC/AHA guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, the ACC Statin Intolerance app is meant to enable clinicians to:
- Answer questions to evaluate possible intolerance to a patient’s current statin prescription.
- Follow steps to manage and treat a patient who reports muscle symptoms on a statin.
- Compare statin characteristics and drug interactions to inform management of LDL-related risk.
The core functionality in the app is under the “Evaluate” header, which presents you with a series of questions to assess rhabdomyolysis likelihood, muscle symptoms, patient demographics, and current statin and drug interactions. Once these are input, the app calculates the likelihood of the muscle symptoms being statin-related (“possible” or “unlikely”) and then provides next steps, all of which can be shared via email.
After the evaluation, you can move on to “Follow-Up,” which provides another decision-support workflow for each of the five steps in the follow-up process: lab values have been obtained, patient was taken off original statin, patient has been re-challenged with original statin, consider starting patient on alternative statin, and muscle symptoms returned on alternative statin. Each of these steps has follow-up questions that then return recommendations and next steps.
While the core functionality lies in the “Evaluation” and “Follow-Up” sections, the Statin Intolerance app also includes a “Statin Drug Comparison” tool to help develop a dosing strategy, as well as a host of additional resources such as “Blood Cholesterol” and “Lifestyle” recommendations that can be shared with patients.
By simplifying otherwise complex guidelines into a streamlined decision-support tool, the Statin Intolerance app should help save time at the point of care. It’s important to note that the app is not a stand-alone decision-support tool and needs to be combined with appropriate clinical judgment to account for differences in patient presentations and needs.
You can download the app for Apple and Android devices here: ACC.org/StatinIntoleranceApp. You can also use the web version of the app by navigating to that link.
Fitchett DH, Hegele RA, Verma S. Circulation. 2015;131:e389-391.
Shiv Gaglani is an MD/MBA candidate at the Johns Hopkins School of Medicine and Harvard Business School. He writes about trends in medicine and technology and has had his work published in Medgadget, The Atlantic, and Emergency Physicians Monthly.
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