Contemporary Primary Prevention Aspirin Use by Cardiovascular Disease Risk: Impact of US Preventive Services Task Force Recommendations, 2007—2015: A Serial, Cross‐sectional Study

Abstract

BackgroundNo previous study has evaluated the impact of past US Preventive Services Task Force statements on primary prevention (PP) aspirin use in a primary care setting. The aim of this study was to evaluate temporal changes in PP aspirin use in a primary care population, stratifying patients by their 10‐year global cardiovascular disease risk, in response to the 2009 statement.Methods and ResultsThis study estimated biannual aspirin use prevalence using electronic health record data from primary care clinics within the Fairview Health System (Minnesota) from 2007 to 2015. A total of 94 270 patient encounters had complete data to estimate a 10‐year cardiovascular disease risk score using the 2013 American College of Cardiology/American Heart Association global risk estimator. Patients were stratified into low‐ (<10%), intermediate‐ (10–20%), and high‐ (≥20%) risk groups. Over the 9‐year period, PP aspirin use averaged 43%. When stratified by low, intermediate and high risk, average PP aspirin use was 41%, 63%, and 73%, respectively. Average PP aspirin use decreased after the publication of the 2009 US Preventive Services Task Force recommendation statement: from 45% to 40% in the low‐risk group; from 66% to 62% in the intermediate‐risk group; and from 76% to 73% in the high‐risk group, before and after the guideline.ConclusionsPublication of the 2009 US Preventive Services Task Force recommendation was not associated with an increase in aspirin use. High risk PP patients utilized aspirin at high rates. Patients at intermediate risk were less intensively treated, and patients at low risk used aspirin at relatively high rates. These data may inform future aspirin guideline dissemination.

Aspirin Use for Cardiovascular Disease Prevention in an African American Population: Prevalence and Associations with Health Behavior Beliefs

“…After adjustment for age, sex and CVD risk factors, only hypertension and diabetes remained positively associated with aspirin use. This contrasts with the REGARDS study [18] and a large clinical sample [15] where all risk factors remained significantly associated with aspirin use after similar adjustment. This may be due to the smaller sample size in the current study.…”

“…There is evidence of suboptimal primary prevention aspirin use in moderate to high risk individuals [15]. Contemporary preventive aspirin use rates among African Americans are limited but historically have been lower than aspirin use in Whites for both primary and secondary prevention [16][17][18][19][20][21].…”

“…Contemporary preventive aspirin use rates among African Americans are limited but historically have been lower than aspirin use in Whites for both primary and secondary prevention [16][17][18][19][20][21]. Guidelines for aspirin do little to influence use [15], likely related in part to the difficulty in changing both provider and patient patterns of behavior. Behavior change techniques are an area of interest not only for treatment adherence but for many healthy lifestyle adjustments [22].…”

Aspirin for primary prevention: Is this the end of the road?

“…This adverse benefit-risk trade-off is reflected in recent trends indicating a reduction in the use of aspirin for primary prevention in the United States. 33 …”

<p>Estimation of Cardiovascular Risk from Self-Reported Knowledge of Risk Factors: Insights from the Minnesota Heart Survey</p>

“…The PCE risk calculator, however, will not calculate risk if any of the input values are missing. In a study by Van't Hof et al, 5 only 43% of a primary prevention clinic population had complete data to allow PCE risk calculation using electronic health record data. The electronic health record data did contain ICD-9 CM diagnostic codes for hypertension and hyperlipidemia, which, had they been incorporated, might have allowed many more individuals to be assessed.…”