Cardio App of the Month: ACS Trials

Last month we discussed the clinical evidence summary app (CESA) Journal Club,¹ which summarizes and criticizes internal medicine literature. CESAs focusing on cardiology subspecialities have been around for several years. (Sadly, the excellent CHF Trials app is now unavailable.) ACS Trials is one such cardiology-focused CESA that covers literature related to ACS and stable CAD. It is available for iOS for $2.99.

ACS Trials was developed by a group of clinicians primarily at Washinton University. St. Louis. It combines its database of trial interpretations with a selection of medical calculators. Let’s start with the trial database.

Trial database

ACS Trials’ database boasts >80 high-impact summaries of RCTs of interventions and medications related to ACS and stable CAD. Each summary starts with a brief ‘Take Home Message’, which is a short interpretation of the trial, then the ‘Summary’ section, which discusses each trial in the context of the greater medical literature. The subsequent sections cover the meat of the trial, namely design, inclusion/exclusion criteria, and methods. The baseline characteristics and endpoint data sections present number-heavy subjects in easy-to-digest pieces. ACC/AHA guidelines are incorporated when relevant, but it isn’t apparent which year’s guidelines are presented. The end of the summary is links to PubMed and the publisher’s site.

The database can be sorted by trial name, subject, drug, and year of publication. Sorting by year reveals that only one trial published since 2013 has been added to the database. 

Calculators

The app includes 34 medical calculators relevant to cardiology and a handful of non-cardiology ones that are somewhat out-of-place (eg, SIRS criteria). Unfortunately, the cardiology-relevant calculators incomplete and out of date. For example, the device contains an ATP III guideline management algorithm and CHADS₂ calculator, but lacks an ASCVD 10 year risk estimator and CHA₂DS₂-VASc and HAS-BLED calculators. The calculators included are easy to use and include bonus references to validation studies.

Updates down the road?

ACS Trials updates its database with each app revision, which occurred 10 times between 2011-2014 but only once in 2015. This means that the content hasn’t been expanded in over a year. Will there be updates in the future? If the app’s support page is any indication – it doesn’t look good since it’s a Squarespace 404 error page.² Emails to the developer did not receive a response.

Conclusion

ACS Trials is a handy database of classic trials for ACS and stable CAD. It also has some calculators, but this pales in comparison to dedicated calculator packages like MDCalc.³ The trial database is very useful but needs an update. Hopefully we’ll see one soon.  One commenter noted on the iTunes page that he would have given [the app] 5 stars if the content was current. “Otherwise,” the comment notes, “a history book of ACS science. Nonetheless, worth the money.” I agree.