Decision support only. Not medical advice. Consult a licensed clinician before initiating or changing therapy.

Patient 003

61y·male·white·ASCVD 22.7% · SBP 148 mmHg · Chol 230 mg/dL · smoker

2 active reversal flags

  1. CardiologyCritical

    Class 1C antiarrhythmics post-myocardial infarction

    Why flagged

    Class 1C antiarrhythmic (flecainide/encainide) contraindicated: patient has structural heart disease or prior MI; CAST 1989 showed 2.5x increase in cardiovascular mortality.

    1. Prior guidance1989

      Routine use of Class 1C antiarrhythmics to suppress PVCs following myocardial infarction to prevent sudden death (Pre-1989 standard of care).

    2. CAST1989

      Flecainide and Encainide increased cardiovascular mortality risk 2.5 times (RR 2.5; 95% CI 1.7-8.5) compared to placebo.

    3. Reversal1992

      Guidelines updated

    4. Current recommendation

      ACC/AHA guidelines: Absolute contraindication for Class 1C antiarrhythmics (flecainide, encainide) in patients with prior MI or structural heart disease.

  2. CardiologyHigh

    Aspirin for primary CVD prevention

    Why flagged

    On aspirin for primary prevention at age 60+, reversed by USPSTF 2022 (Grade D).

    1. Prior guidance2016

      Routine low-dose aspirin for primary prevention in adults 50-59 years with >= 10% 10-year ASCVD risk (USPSTF, 2016).

    2. ASPREE2018

      Increased major hemorrhage (HR 1.38; 95% CI 1.18-1.62) and higher all-cause mortality (5.9% vs. 5.7%) in elderly patients, with no CVD benefit.

    3. Reversal2022

      Guidelines updated

    4. Current recommendation

      USPSTF (2022): Grade D against initiating aspirin for primary prevention in adults >= 60 years. Grade C (individualized decision) for adults 40-59 years with >= 10% ASCVD risk.