Update ASCVD app to support new clinical recommendations (#2)

Author: zplata

CHANGELOG.md

@@ -1,5 +1,7 @@
 # CHANGELOG
 
+* 1.1.0
+    - Update recommendation text to have more clinical value 
 * 1.0.0
     - Implemented UI design with React
     - Implemented ASCVD Risk Score algorithm

build/js/bundle.js

@@ -1,6 +1,6 @@
 {
   "name": "ascvd-risk-app",
-  "version": "1.0.0",
+  "version": "1.1.0",
   "author": "Cerner Corporation, SMART on FHIR",
   "description": "SMART ASCVD Risk App",
   "license": "Apache-2.0",

package.json

@@ -235,31 +235,36 @@ module.exports = {
   'Recommendations view with content': (browser) => {
     browser
       .url(`http://localhost:${browser.globals.webpackDevServerPort}/recommendations.html`)
-      .assert.containsText('#recSmoker .detail_box__title', 'Quit smoking')
-      .assert.containsText('#recSmoker .detail_box__description', 'Your risk of heart attack or stroke decreases ' +
-      'soon after you quit smoking. Blood flow to the heart and brain is vital, and increases ' +
-      'almost immediately after your last cigarette. Additionally, the rate of plaque build-up ' +
-      'in your blood vessels decreases. Ask your doctor about smoking cessation aids proven ' +
-      'to be effective.')
+      .assert.containsText('#recSmoker .detail_box__title', 'Quit Smoking')
+      .assert.containsText('#recSmoker .detail_box__description', 'Besides causing cancer and lung disease, smoking ' +
+        'is a leading cause of stroke and heart attack. Nicotine replacement (patches, gum, lozenges), ' +
+        'coaching programs, and medications (Chantix, Buproprion) can increase your chances of success. ' +
+        'See www.smokefree.gov for more information.')
       .assert.containsText('#recStatin .detail_box__title', 'Consider a statin')
-      .assert.containsText('#recStatin .detail_box__description', 'Statins lower LDL (bad) cholesterol ' +
-      'and raise HDL (good) cholesterol in your blood. Improved cholesterol levels decrease your ' +
-      'risk for a heart attack or a stroke. Discuss the benefits and risks of statins with ' +
-      'your doctor.')
-      .assert.containsText('#recAspirin .detail_box__title', 'Take an aspirin every day')
-      .assert.containsText('#recAspirin .detail_box__description', 'Taking an aspirin daily can ' +
-      'reduce your risk of heart attacks and strokes, or reduce the severity of such an event. ' +
-      'Your doctor can provide guidance on the recommended daily dose that’s right for you.')
-      .assert.containsText('#recBP .detail_box__title', 'Control your blood pressure')
-      .assert.containsText('#recBP .detail_box__description', 'High blood pressure stresses your ' +
-      'body’s blood vessels, weakening them and greatly increasing your risk for heart attack or stroke.' +
-      ' Blood pressure medications, weight control, exercise, and managing your sodium intake can ' +
-      'all have positive impact on your blood pressure.')
-      .assert.containsText('#recExercise .detail_box__title', 'Exercise')
-      .assert.containsText('#recExercise .detail_box__description', 'Regular physical activity helps ' +
-      'you control your weight, blood pressure, and cholesterol. Be sure to consult your doctor ' +
-      'before starting an exercise program.')
-      .click('#recSmoker .detail_box__header')
+      .assert.containsText('#recStatin .detail_box__description', 'Statins can reduce your risk of heart attack or ' +
+        'stroke by 25%, even if your cholesterol level is in the “normal” range. The American Heart ' +
+        'Association and American College of Cardiology recommend statins for people with diabetes, prior ' +
+        'heart disease or stroke, and people at high risk of developing heart disease.')
+        .assert.containsText('#recAspirin .detail_box__title', 'Aspirin')
+      .assert.containsText('#recAspirin .detail_box__description', 'Aspirin can help lower your risk of heart attack ' +
+        'or stroke by about 10%. Aspirin may increase your risk of bleeding. Talk to your doctor about ' +
+        'whether you may benefit from taking aspirin daily and what dose may be the best.')
+        .assert.containsText('#recBP .detail_box__title', 'Control your blood pressure')
+      .assert.containsText('#recBP .detail_box__description', 'Every 10 point lowering of your systolic blood pressure ' +
+        'or 5 point lowering of your diastolic blood pressure can lower your risk of heart disease by 21%. High blood ' +
+        'pressure can be treated with diet, weight loss, and medications. Lowering your sodium intake to 2,400 mg per ' +
+        'day or even as low as 1,000 mg per day can help lower your blood pressure. Different people benefit from ' +
+        'different goal blood pressures. Ask your doctor what your goal should be.')
+      .assert.containsText('#recExercise .detail_box__title', 'Exercise More')
+      .assert.containsText('#recExercise .detail_box__description', 'The American Heart Association and American College ' +
+        'of Cardiology recommend 3-4 sessions per week of at least 40 minutes per session of moderate to vigorous ' +
+        'physical activity. But even small increases in your amount of physical activity can improve your heart health.')
+        .assert.containsText('#recEating .detail_box__title', 'Eat more Heart-Healthy Food')
+      .assert.containsText('#recEating .detail_box__description', 'Try to limit your intake of sugar, including sweets ' +
+        'and sugar sweetened drinks. Eating more vegetables, fruits, whole grains, low-fat dairy, poultry (chicken), ' +
+        'fish, beans, olive oil and nuts can help lower your risk of heart disease. Try to avoid or reduce trans fat and ' +
+        'saturated fat, which are high in lard, butter, red meat, and fried foods.')
+        .click('#recSmoker .detail_box__header')
       .assert.hidden('#recSmoker .detail_box__description')
       .assert.visible('#recSmoker .detail_box__title');
   }

tests/nightwatch/ascvd-risk.spec.js

@@ -14,7 +14,7 @@ import DetailBox from '../../../components/DetailBox/detail_box';
 describe('<Recommendations />', () => {
   it('should render at least 4 recommendations', () => {
     let wrapper = shallow(<Recommendations />);
-    expect(wrapper.find(DetailBox)).toHaveLength(5);
+    expect(wrapper.find(DetailBox).length).toBeGreaterThanOrEqual(4);
   });
 
   it('should not render a recommendation to quit smoking if patient is not currently a smoker', () => {
@@ -27,6 +27,6 @@ describe('<Recommendations />', () => {
     ASCVDRisk.patientInfo.relatedFactors.smoker = true;
     let wrapper = shallow(<Recommendations />);
     expect(wrapper.find('.hidden')).toHaveLength(0);
-    expect(wrapper.find(DetailBox)).toHaveLength(5);
+    expect(wrapper.find(DetailBox).length).toBeGreaterThan(4);
   });
 });

tests/views/Recommendations/Recommendations.spec.js

@@ -28,44 +28,58 @@ class Recommendations extends React.Component {
   render() {
     return (
       <div className={styles.container}>
-        <div id={'recSmoker'} className={Recommendations.shouldHide('smoker')}>
+        <div id={'recStatin'}>
           <DetailBox
-            boxHeader={'Quit smoking'}
-            boxBody={`Your risk of heart attack or stroke decreases soon after you quit smoking.
-              Blood flow to the heart and brain is vital, and increases almost immediately after your last
-              cigarette. Additionally, the rate of plaque build-up in your blood vessels decreases. Ask your
-              doctor about smoking cessation aids proven to be effective.`}
+            boxHeader={'Consider a statin'}
+            boxBody={`Statins can reduce your risk of heart attack or stroke by 25%, even if your
+              cholesterol level is in the “normal” range. The American Heart Association and American College
+              of Cardiology recommend statins for people with diabetes, prior heart disease or stroke, and
+              people at high risk of developing heart disease.`}
           />
         </div>
-        <div id={'recStatin'}>
+        <div id={'recBP'}>
           <DetailBox
-            boxHeader={'Consider a statin'}
-            boxBody={`Statins lower LDL (bad) cholesterol and raise HDL (good) cholesterol in your blood.
-              Improved cholesterol levels decrease your risk for a heart attack or a stroke. Discuss the benefits
-              and risks of statins with your doctor.`}
+            boxHeader={'Control your blood pressure'}
+            boxBody={`Every 10 point lowering of your systolic blood pressure or 5 point lowering of
+              your diastolic blood pressure can lower your risk of heart disease by 21%. High blood pressure
+              can be treated with diet, weight loss, and medications. Lowering your sodium intake to 2,400 mg
+              per day or even as low as 1,000 mg per day can help lower your blood pressure.\n\n Different people
+              benefit from different goal blood pressures. Ask your doctor what your goal should be.`}
           />
         </div>
-        <div id={'recAspirin'}>
+        <div id={'recExercise'}>
           <DetailBox
-            boxHeader={'Take an aspirin every day'}
-            boxBody={`Taking an aspirin daily can reduce your risk of heart attacks and strokes, or reduce
-              the severity of such an event. Your doctor can provide guidance on the recommended daily dose that’s
-              right for you.`}
+            boxHeader={'Exercise More'}
+            boxBody={`The American Heart Association and American College of Cardiology recommend
+              3-4 sessions per week of at least 40 minutes per session of moderate to vigorous
+              physical activity. But even small increases in your amount of physical activity
+              can improve your heart health.`}
           />
         </div>
-        <div id={'recBP'}>
+        <div id={'recEating'}>
           <DetailBox
-            boxHeader={'Control your blood pressure'}
-            boxBody={`High blood pressure stresses your body’s blood vessels, weakening them and greatly
-              increasing your risk for heart attack or stroke. Blood pressure medications, weight control,
-              exercise, and managing your sodium intake can all have positive impact on your blood pressure.`}
+            boxHeader={'Eat more Heart-Healthy Food'}
+            boxBody={`Try to limit your intake of sugar, including sweets and sugar sweetened drinks.
+              Eating more vegetables, fruits, whole grains, low-fat dairy, poultry (chicken), fish, beans,
+              olive oil and nuts can help lower your risk of heart disease. Try to avoid or reduce trans
+              fat and saturated fat, which are high in lard, butter, red meat, and fried foods.`}
           />
         </div>
-        <div id={'recExercise'}>
+        <div id={'recSmoker'} className={Recommendations.shouldHide('smoker')}>
+          <DetailBox
+            boxHeader={'Quit Smoking'}
+            boxBody={`Besides causing cancer and lung disease, smoking is a leading cause of stroke and
+              heart attack. Nicotine replacement (patches, gum, lozenges), coaching programs, and
+              medications (Chantix, Buproprion) can increase your chances of success. See
+              www.smokefree.gov for more information.`}
+          />
+        </div>
+        <div id={'recAspirin'}>
           <DetailBox
-            boxHeader={'Exercise'}
-            boxBody={`Regular physical activity helps you control your weight, blood pressure, and cholesterol.
-              Be sure to consult your doctor before starting an exercise program.`}
+            boxHeader={'Aspirin'}
+            boxBody={`Aspirin can help lower your risk of heart attack or stroke by about 10%. Aspirin may
+              increase your risk of bleeding. Talk to your doctor about whether you may benefit from taking
+              aspirin daily and what dose may be the best.`}
           />
         </div>
       </div>