Medical Calculators for PAs and Nurse Practitioners

Per ACC/AHA 2018 Cholesterol Guidelines, high-intensity statin therapy is indicated for: established ASCVD, LDL ≥190 mg/dL, or diabetes (age 40–75) with 10-year ASCVD risk ≥7.5%. For primary prevention in patients age 40–75 without the above, calculate 10-year ASCVD risk: <5% = low risk, lifestyle counseling only; 5–7.5% = borderline, risk discussion; 7.5–19.9% = intermediate, moderate-intensity statin recommended; ≥20% = high risk, high-intensity statin. Risk-enhancing factors (CRP ≥2, ABI <0.9, coronary calcium) can prompt treatment at lower thresholds.

USPSTF recommends depression screening for all adults ≥18. PHQ-2 first (score ≥3 = positive screen, proceed to PHQ-9). PHQ-9 severity guides management: 0–4 = minimal (watchful waiting); 5–9 = mild (psychoeducation, follow-up in 4 weeks); 10–14 = moderate (initiate antidepressant or therapy referral); 15–19 = moderately severe (antidepressant + therapy); 20–27 = severe (antidepressant + urgent therapy/psychiatry referral). Always assess question 9 (suicidality) independently. Repeat PHQ-9 at 4–8 weeks to assess treatment response — target ≥50% reduction.

eGFR guides CKD staging, medication dosing adjustments, and nephrology referral. Refer to nephrology: eGFR <30 (Stage 4), rapid decline (>5 mL/min/year), urine ACR >300 mg/g, or uncertain etiology. Medication thresholds: stop metformin at eGFR <30, reduce dose 30–45; avoid NSAIDs at eGFR <30; adjust SGLT2 inhibitors (empagliflozin effective down to eGFR 20 for heart failure); check ACE inhibitor/ARB tolerance at eGFR <30 (expect up to 30% creatinine rise — acceptable if stable). Monitor eGFR 2–4 weeks after starting ACE/ARB or SGLT2 inhibitors.

Calculate CHA₂DS₂-VASc score. Per AHA/ACC: anticoagulation recommended for CHA₂DS₂-VASc ≥2 in men or ≥3 in women. Score 1 (men) or 2 (women): shared decision-making — anticoagulation reasonable. Score 0 (men) or 1 (women): no anticoagulation benefit. Preferred agents: DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) over warfarin for non-valvular AFib. Always pair with HAS-BLED to assess bleeding risk and address modifiable bleeding risk factors (uncontrolled hypertension, concurrent antiplatelet use, alcohol excess).

ACC/AHA 2017 guidelines define hypertension as BP ≥130/80 mmHg. Treatment targets: general adults <130/80 mmHg; high CVD risk (10-year ASCVD ≥10%, established CVD, CKD, diabetes) <130/80 mmHg; older adults (≥65) <130 mmHg systolic if tolerated. First-line agents: thiazide diuretics, ACE inhibitors/ARBs, or calcium channel blockers (all equivalent for most patients). For Black patients, thiazides or CCBs preferred. For CKD with proteinuria, ACE inhibitor or ARB is first-line. Lifestyle modifications reduce SBP 4–11 mmHg (DASH diet, sodium restriction, aerobic exercise, weight loss).

The Framingham Risk Score (2008) estimates 10-year risk of coronary heart disease events (MI, coronary death, angina). The Pooled Cohort Equations (ASCVD, 2013 ACC/AHA) predict 10-year risk of first atherosclerotic cardiovascular event (MI or stroke, fatal or non-fatal). ASCVD is now the preferred tool per current guidelines — it includes stroke (a major outcome Framingham misses), was derived from more diverse cohorts, and includes African American race-specific equations. Framingham may overestimate risk in contemporary primary prevention populations.