January 26, 2015
Journal of the American College of Cardiology
Volume 65, Issue 2, January 2015
Ravi S. Hira, MD
TAKE-HOME MESSAGE
- Using a US nationwide registry, the authors examined the frequency and practice-level variation of inappropriate aspirin use for preventing cardiovascular disease (CVD). Overall, the frequency of inappropriate aspirin use was 11.6% (N = 68 808), and it varied significantly among practices. These results were consistent after exclusion of patients with diabetes and after exclusion of women ≥65 years (n = 21 052).
- More than 1 in 10 patients were receiving inappropriate aspirin therapy for the primary prevention of CVD, with significant practice-level variations. Evidence-based aspirin use for CVD prevention should be improved.
– Samer Ajam, MD
Abstract
BACKGROUND
Among patients without cardiovascular disease (CVD) and low 10-year CVD risk, the risks of gastrointestinal bleeding and hemorrhagic strokes associated with aspirin use outweigh any potential atheroprotective benefit. According to the guidelines on primary prevention of CVD, aspirin use is considered appropriate only in patients with 10-year CVD risk ≥6% and inappropriate in patients with 10-year CVD risk <6%.
OBJECTIVES
The goal of this study was to examine the frequency and practice-level variation in inappropriate aspirin use for primary prevention in a large U.S. nationwide registry.
METHODS
Within the National Cardiovascular Disease Registry’s Practice Innovation and Clinical Excellence registry, we assessed 68,808 unique patients receiving aspirin for primary prevention from 119 U.S. practices. The frequency of inappropriate aspirin use was determined for primary prevention (aspirin use in those with 10-year CVD risk <6%). Using hierarchical regression models, the extent of practice-level variation using the median rate ratio (MRR) was assessed.
RESULTS
Inappropriate aspirin use frequency was 11.6% (7,972 of 68,808) in the overall cohort. There was significant practice-level variation in inappropriate use (range 0% to 71.8%; median 10.1%; interquartile range 6.4%) for practices; adjusted MRR was 1.63 (95% confidence interval [CI]: 1.47 to 1.77). Results remained consistent after excluding 21,052 women age ≥65 years (inappropriate aspirin use 15.2%; median practice-level inappropriate aspirin use 13.8%; interquartile range 8.2%; adjusted MRR 1.61 [95% CI: 1.46 to 1.75]) and after excluding patients with diabetes (inappropriate aspirin use 13.9%; median practice-level inappropriate aspirin use 12.4%; interquartile range 7.6%; adjusted MRR 1.55 [95% CI: 1.41 to 1.67]).
CONCLUSIONS
More than 1 in 10 patients in this national registry were receiving inappropriate aspirin therapy for primary prevention, with significant practice-level variations. Our findings suggest that there are important opportunities to improve evidence-based aspirin use for the primary prevention of CVD.