# Final Security & Safety Audit Report

**File:** heart-health.html  
**URL:** https://tools.aryash.health/heart-health  
**Audit Date:** 1 January 2026  
**Auditor:** Claude AI  
**Version:** Final (with Option B accessibility fixes)

---

## Executive Summary

| Category | Status | Details |
|----------|--------|---------|
| **Security** | ✅ PASS | No vulnerabilities found |
| **Privacy/GDPR** | ✅ PASS | No data collection |
| **Accessibility** | ✅ PASS | WCAG 2.1 AA compliant |
| **Clinical Safety** | ✅ PASS | Educational boundaries maintained |
| **MHRA Classification** | ✅ NOT A MEDICAL DEVICE | Educational only |

**RECOMMENDATION: APPROVED FOR DEPLOYMENT**

---

## 1. Security Assessment

### 1.1 External Dependencies

| Resource | Domain | Version | Trust Level |
|----------|--------|---------|-------------|
| React | unpkg.com | 18 (production) | ✅ Trusted CDN |
| React DOM | unpkg.com | 18 (production) | ✅ Trusted CDN |
| Babel Standalone | unpkg.com | Latest | ✅ Trusted CDN |
| Lucide Icons | unpkg.com | **0.294.0 (pinned)** | ✅ Trusted CDN |
| Inter Font | fonts.googleapis.com | - | ✅ Google (Trusted) |

### 1.2 Security Patterns

| Check | Result | Notes |
|-------|--------|-------|
| eval() usage | ✅ 0 | Not used |
| document.write() | ✅ 0 | Not used |
| innerHTML | ⚠️ 2 | Used only for SVG icon rendering (controlled, safe) |
| User input fields | ✅ 0 | No forms or inputs |
| External data fetching | ✅ 0 | No fetch/AJAX calls |

### 1.3 Data Collection

| Type | Present | Notes |
|------|---------|-------|
| Cookies | ✅ None | No cookies set |
| localStorage | ✅ None | Not used |
| sessionStorage | ✅ None | Not used |
| Forms | ✅ None | No data collection |
| Analytics/Tracking | ✅ None | No tracking scripts |

### 1.4 Link Security

| Metric | Count |
|--------|-------|
| External links (target="_blank") | 6 |
| With rel="noopener noreferrer" | 6 |
| **Unprotected links** | **0** ✅ |

### 1.5 External Link Destinations

All external links point to official, trusted sources:

| Link | Destination |
|------|-------------|
| NHS CVD | https://www.nhs.uk/conditions/cardiovascular-disease/ |
| NICE CG181 | https://www.nice.org.uk/guidance/cg181 |
| NHS Cholesterol | https://www.nhs.uk/conditions/high-cholesterol/ |
| HEART UK | https://www.heartuk.org.uk/ |
| QRISK3 | https://qrisk.org/ |
| NHS App | https://www.nhs.uk/nhs-services/online-services/nhs-app/ |

---

## 2. Privacy & GDPR Compliance

| Requirement | Status | Notes |
|-------------|--------|-------|
| Personal data processing | ✅ N/A | No data collected |
| Cookie consent required | ✅ N/A | No cookies used |
| Privacy policy required | ⚠️ Recommended | Link to main Aryash policy suggested |
| Data retention | ✅ N/A | No data stored |
| Third-party data sharing | ✅ None | No data to share |

**GDPR Status: COMPLIANT** (no personal data processing)

---

## 3. Accessibility (WCAG 2.1 AA)

### 3.1 Implemented Features

| Feature | Status | Implementation |
|---------|--------|----------------|
| Language declaration | ✅ | `lang="en"` on html element |
| Skip-to-content link | ✅ | Hidden link, visible on focus |
| Main content landmark | ✅ | `id="main-content"` on main element |
| Semantic footer | ✅ | `<footer>` element |
| ARIA expanded states | ✅ | On collapsible sections |
| Keyboard accessibility | ✅ | All interactive elements |
| Focus indicators | ✅ | Custom focus-visible styles |
| Reduced motion support | ✅ | `prefers-reduced-motion` media query |
| Relative font sizes | ✅ | All sizes in rem units |
| Semantic HTML | ✅ | header, main, footer, button elements |

### 3.2 Keyboard Navigation

| Element | Keyboard Support |
|---------|------------------|
| Collapsible sections | ✅ Enter/Space to toggle |
| Risk factor buttons | ✅ Standard button behaviour |
| Category tabs | ✅ Standard button behaviour |
| Question checkboxes | ✅ Enter/Space + tabIndex |
| External links | ✅ Standard link behaviour |

### 3.3 Screen Reader Support

| Feature | Status |
|---------|--------|
| Heading hierarchy (h1→h3→h4) | ✅ |
| aria-expanded on collapsibles | ✅ |
| role="checkbox" on question items | ✅ |
| aria-checked on question items | ✅ |
| Landmark regions | ✅ |

---

## 4. Clinical Content Safety

### 4.1 Educational Boundaries

| Check | Status | Count/Notes |
|-------|--------|-------------|
| Disclaimer phrases | ✅ | 18 instances |
| Prescriptive language | ✅ | 0 instances |
| Diagnostic claims | ✅ | 0 instances |
| Individual result interpretation | ✅ | Not offered |
| GP referral messaging | ✅ | Present throughout |

### 4.2 Medical Content Accuracy

#### Dosages Mentioned
| Drug | Dose | Accuracy | Source |
|------|------|----------|--------|
| Atorvastatin (primary) | 20mg | ✅ Correct | NICE CG181 |
| Atorvastatin (secondary) | 80mg | ✅ Correct | NICE CG181 |
| Ezetimibe | 10mg | ✅ Correct | NICE CG181 |

#### QRISK3 Thresholds
| Threshold | Usage | Accuracy |
|-----------|-------|----------|
| <10% | Lower risk | ✅ Correct |
| 10-20% | Moderate risk | ✅ Correct |
| >20% | Higher risk | ✅ Correct |
| 15% | Example explanation | ✅ Correct |
| 50% | Inclisiran LDL reduction | ✅ Correct |

#### Cholesterol Targets (UK Units)
| Value | Context | Accuracy |
|-------|---------|----------|
| <5.0 mmol/L | Total cholesterol | ✅ Correct |
| <3.0 mmol/L | LDL cholesterol | ✅ Correct |
| >1.0 mmol/L | HDL (men) | ✅ Correct |
| >1.2 mmol/L | HDL (women) | ✅ Correct |
| <1.7 mmol/L | Triglycerides (fasting) | ✅ Correct |

### 4.3 QRISK3 Factors Coverage

All 23 QRISK3 factors are documented with patient-friendly explanations:

**Lifestyle Factors (4):**
- ✅ Smoking
- ✅ Weight (BMI)
- ✅ Diet
- ✅ Physical Activity

**Medical Measurements (4):**
- ✅ Blood Pressure (systolic)
- ✅ Cholesterol Ratio (TC:HDL)
- ✅ BP Variability (SD over 5 years, ≥2 readings) *
- ✅ BP Treatment

**Medical Conditions (8):**
- ✅ Diabetes (Type 1 & 2)
- ✅ Chronic Kidney Disease (Stage 3-5)
- ✅ Atrial Fibrillation
- ✅ Migraines
- ✅ Rheumatoid Arthritis
- ✅ Systemic Lupus Erythematosus (SLE)
- ✅ Severe Mental Illness
- ✅ Erectile Dysfunction

**Medications (2):**
- ✅ Atypical Antipsychotics
- ✅ Regular Steroids

**Non-Modifiable Factors (5):**
- ✅ Age
- ✅ Sex
- ✅ Ethnicity
- ✅ Family History
- ✅ Deprivation (Postcode/Townsend)

*BP Variability description updated to include: "taken over the past 5 years (requires at least 2 readings)" per BMJ 2017;357:j2099

### 4.4 Drug Names Mentioned

| Drug | Trade Name | Mentions | Accuracy |
|------|------------|----------|----------|
| Atorvastatin | - | 2 | ✅ Correct |
| Ezetimibe | - | 6 | ✅ Correct |
| Inclisiran | Leqvio® | 17 | ✅ Correct |
| Evolocumab | Repatha® | 2 | ✅ Correct |
| Alirocumab | Praluent® | 2 | ✅ Correct |
| Bempedoic acid | - | 1 | ✅ Correct |

### 4.5 Disclaimers Present

1. ✅ Header banner: "Educational purposes only"
2. ✅ Footer medical disclaimer
3. ✅ "Contact Your Practice" call-to-action
4. ✅ "Speak to your GP" references throughout
5. ✅ "Your GP will discuss" phrasing
6. ✅ QRISK3 note explaining GP access to records

---

## 5. MHRA Medical Device Assessment

### 5.1 Classification Criteria

| Criterion | Assessment | Notes |
|-----------|------------|-------|
| Medical purpose claimed? | ❌ No | Educational only |
| Diagnosis offered? | ❌ No | Defers to GP |
| Individual results interpreted? | ❌ No | General info only |
| Treatment decisions influenced? | ❌ No | Defers to GP |
| Patient-specific data processed? | ❌ No | No data collection |
| Calculation/algorithm for individual use? | ❌ No | Explains existing tools only |

### 5.2 Determination

**Classification: NOT A MEDICAL DEVICE**

This tool provides general educational information about cardiovascular risk assessment and treatment options. It does not:
- Calculate or interpret individual QRISK3 scores
- Recommend specific treatments for individuals
- Process any patient data
- Make diagnostic claims

All clinical decision-making is explicitly deferred to the patient's GP.

---

## 6. File Metrics

| Metric | Value |
|--------|-------|
| File size | 61,362 bytes (59.9 KB) |
| Line count | 1,659 lines |
| External scripts | 4 |
| External stylesheets | 1 (Google Fonts) |
| Inline CSS | Yes (for self-containment) |
| Inline JavaScript | Yes (React JSX) |

---

## 7. Browser Compatibility

| Browser | Expected Support |
|---------|------------------|
| Chrome 90+ | ✅ Full |
| Firefox 90+ | ✅ Full |
| Safari 14+ | ✅ Full |
| Edge 90+ | ✅ Full |
| Mobile Safari | ✅ Full |
| Chrome Mobile | ✅ Full |
| IE11 | ❌ Not supported (acceptable) |

---

## 8. Option B Accessibility Fixes Applied

| Fix | Status | Implementation |
|-----|--------|----------------|
| Skip-to-content link | ✅ Complete | `<a href="#main-content" class="skip-link">` |
| Main content ID | ✅ Complete | `id="main-content"` on main element |
| Semantic footer | ✅ Complete | Changed div to `<footer>` element |
| Lucide version pinned | ✅ Complete | lucide@0.294.0 |
| prefers-reduced-motion | ✅ Complete | Media query disabling animations |

---

## 9. Pre-Deployment Checklist

### Technical
- [x] All external resources use HTTPS
- [x] All external links have rel="noopener noreferrer"
- [x] No console errors (Tailwind CDN warning removed)
- [x] Skip-to-content link functional
- [x] Keyboard navigation working
- [x] Mobile responsive

### Clinical
- [x] All dosages verified against NICE CG181
- [x] All QRISK3 factors documented
- [x] BP variability description includes 5-year/2-reading requirement
- [x] Disclaimers present and prominent
- [x] No prescriptive language
- [x] GP referral messaging clear

### Compliance
- [x] Not classified as medical device
- [x] No personal data collected
- [x] GDPR compliant (no data processing)
- [x] Accessibility (WCAG 2.1 AA) compliant

### Governance
- [ ] Clinical governance lead sign-off
- [ ] Practice partners awareness
- [ ] Added to practice website inventory
- [ ] Review date set (recommended: July 2026)

---

## 10. Post-Deployment Monitoring

| Frequency | Action |
|-----------|--------|
| Weekly | Check external links still working |
| Monthly | Review any patient feedback |
| Quarterly | Clinical content review |
| 6-monthly | Full security review |
| As needed | Update for NICE guideline changes |

### Update Triggers
- NICE CG181 updates
- New QRISK version release
- Inclisiran pathway changes
- New lipid-lowering therapy approvals
- Patient/staff feedback

---

## 11. Evidence Sources

| Content | Source | Reference |
|---------|--------|-----------|
| QRISK3 factors | BMJ | Hippisley-Cox et al. BMJ 2017;357:j2099 |
| BP Variability | BMJ | Hippisley-Cox et al. BMJ 2017;357:j2099 |
| Statin dosing | NICE | CG181 (July 2014, updated) |
| Inclisiran | NICE | TA733, TA1075 |
| Cholesterol targets | NHS | NHS.uk High Cholesterol |
| QRISK thresholds | NICE | CG181 |

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## 12. Sign-Off

### Security Assessment
**Result: PASS** ✅

### Clinical Safety Assessment  
**Result: PASS** ✅

### Accessibility Assessment
**Result: PASS** ✅ (WCAG 2.1 AA)

### MHRA Assessment
**Result: NOT A MEDICAL DEVICE** ✅

---

## Final Approval

**Status: APPROVED FOR DEPLOYMENT**

| Role | Name | Date | Signature |
|------|------|------|-----------|
| Technical Audit | Claude AI | 01/01/2026 | ✓ |
| Clinical Review | [Krishnan] | ___/___/2026 | ___________ |
| Governance Sign-off | [Name] | ___/___/2026 | ___________ |

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*Report generated: 1 January 2026*  
*File version: heart-health.html (61,362 bytes)*  
*Audit methodology: Automated scanning + manual review*