The AnticoagEvaluator is a web and mobile app that helps clinicians make informed decisions on initiation of antithrombotic therapy for patients with atrial fibrillation (AF) who do not have moderate to severe mitral stenosis or a mechanical heart valve. The app, originally released in 2013, has gone through several updates over the years to incorporate new information, and has now been updated with recommendations from the 2019 ACC/AHA/HRS Focused Update to the 2014 ACC/AHA/HRS Guideline for the Management of Patients with AF.

Clinicians can use the app to:

• Calculate a patient's stroke risk (CHA2DS2-VASc) and renal function (Cockcroft-Gault Equation), and review factors that may contribute to bleed risk (HAS-BLED and concomitant meds)
• Review updated stroke prevention therapy guidance based on the 2019 ACC/AHA/HRS Focused Update of the 2014 ACC/AHA/HRS Guideline for the Management of Patients with AF
• Improve accurate use of direct oral anticoagulants with adjusted dosage based on prescribing information, fine-tuned for renal and other patient characteristics
• Determine appropriate therapy for a patient by reviewing:
• Synthesized individualized risk for antithrombotic therapy options based on clinical trials (i.e., ACTIVE-A, RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE-AF)
• Relevant safety information and full prescribing information for all therapy options

• Version 3.0 of the app now incorporates recommendations from the 2019 ACC/AHA/HRS Focused Update of the 2014 ACC/AHA/HRS Guideline for the Management of Patients with Atrial Fibrillation.
• Safety information in the app now includes guidance on anticoagulation reversal strategies.

Updates from previous versions of the app include:

• Following U.S. Food and Drug Administration approval, edoxaban was added to the list of available anticoagulant therapy options
• The app was updated to include the Cockcroft-Gault Equation to calculate creatinine clearance, and provides renal-function-adjusted dosing from the prescribing information for all the direct oral anticoagulants
• The overall app has been updated with a refreshed look and feel based on user feedback
• The app is available on the web as well as Apple and Android devices

The AnticoagEvaluator is free for both ACC members and non-members.

• If you have previously downloaded the AnticoagEvaluator before January 2019:
  • iPhone and iPad users: Simply accept the latest update to the AnticoagEvaluator on your device to upgrade to the new version
  • Android users: You will need to delete the old version from your device and download the new version from the Google Play app store
• If you are new to the AnticoagEvaluator:
  • To download on a mobile device (Apple or Android), search "AnticoagEvaluator" in the iTunes or Google Play app stores
  • To access on the web, click here.

The AnticoagEvaluator is intended to help clinicians make informed decisions on initiation of antithrombotic therapy for patients with atrial fibrillation (AF) who do not have moderate to severe mitral stenosis or a mechanical heart valve. Clinicians should use this tool to calculate a patient's risk of ischemic stroke and thromboembolism, assess renal function, and evaluate factors contributing to bleed risk. Clinicians can then review the latest guideline-driven therapy recommendations for stroke prevention based on this assessment; generate individualized risk for antithrombotic therapy options based on individual clinical trials; and improve accurate use of direct oral anticoagulants with adjusted dosage based on prescribing information, fine-tuned for renal and other patient characteristics.

The information and recommendations in the app are meant to support clinical decision making. They are not meant to represent the only or best course of care or replace clinical judgment. Therapeutic options should be determined after discussion between the patient and their care provider. The app applies only to patients with AF, who do not have moderate to severe mitral stenosis or a mechanical heart valve. Lastly, while the app provides data for the different anticoagulation therapy options based on clinical trials in combination with individual risk factors, this data is not the result of head-to-head trials, and cannot and should not be used to compare safety and efficacy across drugs.

Therapy guidance is derived from the 2019 ACC/AHA/HRS Focused Update of the 2014 ACC/AHA/HRS Guideline on the Management of Patients with Atrial Fibrillation. Dosing recommendations come from the prescribing information for each individual medication. Risk/benefit information was adapted from a web tool created by Peter Loewen, BSc(Pharm), ACPR, PharmD, FCSHP, which can be viewed here. Individual references for the calculators within the app can be found within the "Resources" section of the app. The SPARCtool may have been updated since the most recent publication of the app.

This app was originally developed as part of the ACC's Anticoagulation Initiative, a comprehensive quality effort to improve care for patients on anticoagulation therapy, and driven and validated by the ACC's Anticoagulation Workgroup, whose hard work is invaluable to the overall Anticoagulation Initiative. The app was further refined and vetted through the oversite of the ACC's Best Practice and Quality Improvement Subcommittee, as well as review and user testing by physicians, nurse practitioners, pharmacists and other relevant specialists. This most recent content update was also completed with input from the 2019 Atrial Fibrillation Guideline Focused Update writing group.

Financial support for the original app was provided by Daiichi Sankyo, Inc. All content has been independently developed with no sponsor involvement.

Mobile tools and apps have the great advantage of being quickly and easily disseminated in care settings and able to gather robust and diverse feedback on the app's performance and utility in those settings. When new studies are published and new therapies become available, the ACC will continually update and improve all its apps and other clinical tools to ensure accuracy and utility.

You can provide thoughts, feedback and suggestions on the AnticoagEvaluator app in two ways:

• Fill out ACC's official feedback survey here. You can also access the survey through the "About the App" section in the app
• Leave comments on the iTunes or Google Play page for the app

The ACC is also collecting data on the app through a variety of additional mechanisms – analytics, usability studies and an impact study. The ACC hopes to translate comments into future updates to the app.

The app is targeted to clinicians who care for patients with atrial fibrillation who do not have moderate to severe mitral stenosis or a mechanical heart valve. It is not directly intended for patient use.

The app is attended to be used by clinicians as part of clinical practice. However, it is freely available to all users, including patients.

No patient information is collected and stored in the app. Anonymous user behavior (i.e., number of people who downloaded the app, how many times a day the app was used) will be gathered through Google Analytics.

The AnticoagEvaluator app is a product of ACC's Anticoagulation Initiative, a multidisciplinary effort that addresses gaps in knowledge in order to develop processes and tools aimed at meeting guideline-recommended standards and improving quality of anticoagulation care. It is also part of the ACC's growing Clinical Mobile App Collection, all designed to be used "on the go" to help optimize patient care. More information about ACC's Clinical App Collection can be found here.

The therapy guidance in the app is derived from the 2019 ACC/AHA/HRS Focused Update of the 2014 ACC/AHA/HRS Guideline for the Management of Patients with Atrial Fibrillation.

Electronic medical record (EMR) capabilities are not currently built into this version of the AnticoagEvaluator. However, the app does provide the capability to email the results of individual sessions within the app, which can then be transferred into EMR notes. The ACC is also piloting electronic health record integration for some of our other clinical apps and hopes to eventually make this a standard feature of our mobile clinical tools.

Contact the ACC at 1-800-253-4636 or membercare@acc.org.