PreventS-MD

The PreventS-MD software is designed for clinicians who can use it in conjunction with the electronic patient management system of outpatient clinics and hospitals. This software is built on the award-winning Stroke Riskometer algorithm. By communicating with the electronic patient management system of the health provider, PreventS-MD allows automatic pre-population of information on stroke risk factors to calculate an absolute and relative 5-year risk of stroke and generate patient-tailored recommendations for primary and secondary stroke prevention for the individual patient.

These two digital tools are complementary to each other and ideally should be used in tandem − HCPs use the PreventS-MD webapp on their office computers and/or portable devices while lay persons and community workers use the Stroke Riskometer mobile app on their smartphones and portable devices.

For individuals willing to update their risk data on the Stroke Riskometer app using the PreventS-MD screening results, there is an option to transfer the PreventS-MD data to the Stroke Riskometer app, using a QR code. It is also possible for nurses in outpatient clinics or hospital wards to pre-enter variables in PreventS-MD and wirelessly transfer the data to the doctor’s office computer, thus saving the treating physician’s time on data entry when they assess the individual.

PreventS-MD will help healthcare professionals and policy makers to enhance their electronic patient management systems by providing a tool to improve prevention of stroke and other major NCDs that share common risk factors with stroke. The wider community will benefit from the use of the PreventS webapp by becoming more aware of their own risk of stroke and the modifiable lifestyle changes that can be changed in order to reduce the risk.

In the PreventS-MD webapp we included an acute coronary syndrome prediction algorithm that was also derived from the Framingham Heart Study. In addition to the risk factors used in the Stroke Riskometer app for estimating the risk of stroke, we included two additional risk factors (total cholesterol and high-density lipoprotein cholesterol) required for estimation of the risk of acute coronary syndrome. PreventS-MD also includes an option for the treating physician to set a ‘recommended systolic blood pressure for the individual’ as one of the goal settings for the individual.

Unlike any other digital applications for stroke and CVD predictions, these cognitive behavioural theory-based tools provide estimates of not only absolute 5 and 10-year risks but also relative risk of stroke and acute coronary syndrome for persons of different race/ethnicity aged 20−93 years. Risk of acute coronary syndrome is estimated only for persons aged 30−74 years, without history of cardiovascular disease and when data on total and high density lipid cholesterol are available. This way of communicating risk assessment and management can lead to increased motivation for behavioural change. Furthermore, both digital tools contain graphical easy to-understand visualisation of the risks and their trends over time, ‘ideal’ levels of risk factors for the individual, goal setting options, medication reminders, and evidence-based recommendations for primary and secondary stroke and CVD prevention.

Along with secondary stroke prevention, the software provides an opportunity for stroke risk assessment in primary care, with a strong emphasis on prevention messages. This includes the potential to transfer assessments and risk information via a QR code to the patient’s mobile phone via the Stroke Riskometer app for additional motivation strategies for self-management. The software is currently undergoing integration arrangement with the patient management platforms at outpatient clinics and local hospitals. Besides New Zealand, several international research collaborations and projects are underway for establishing feasibility and efficacy of PreventS-MD in the primary and secondary stroke prevention space.

References

• Feigin, V.L., Owolabi, M.O., on behalf of the World Stroke Organization-Lancet Neurology Commission Stroke Collaboration Group (2023) Pragmatic solutions to reduce the global burden of stroke: A World Stroke Organization - Lancet Neurology Commission. The Lancet Neurology, 22(12), 1160-1206. doi: 10.1016/S1474-4422(23)00277-6
• Feigin, V. L., Krishnamurthi, R., Medvedev, O., Merkin, A., Nair, B., Kravchenko, M., . . . Hankey, G. (On behalf of the PreventS study team) (2023). Usability and feasibility of PreventS-MD webapp for stroke prevention. International Journal of Stroke, 19(1). doi: 10.1177/17474930231190745
• Feigin, V.L., Krishnamurthi, R., Merkin, A., Nair, B., Kravchenko, M. & Jalili-Moghaddam, S. (2022). Digital solutions for primary stroke and cardiovascular disease prevention: A mass individual and public health approach. The Lancet Regional Health - Western Pacific
• Feigin, V.L., Owolabi, M., Hankey, G.J., Pandian, J.D., & Martins SC. (2022). Digital health in primordial and primary stroke prevention: A systematic review. Stroke, 53, 1008–1019