Original Research

Journal of General Internal Medicine

, Volume 30, Issue 2, pp 155-160

Do Clinicians Recommend Aspirin to Patients for Primary Prevention of Cardiovascular Disease?

  • Kevin FiscellaAffiliated withDepartment of Family Medicine, University of Rochester School of Medicine and DentistryPublic Health Sciences, University of Rochester School of Medicine and Dentistry Email author 
  • , Paul C. WintersAffiliated withDepartment of Family Medicine, University of Rochester School of Medicine and Dentistry
  • , Michael MendozaAffiliated withDepartment of Family Medicine, University of Rochester School of Medicine and DentistryPublic Health Sciences, University of Rochester School of Medicine and Dentistry
  • , Gary J. NoronhaAffiliated withCenter for Primary Care and Department of Internal Medicine, University of Rochester School of Medicine and Dentistry
  • , Carlos M. SwangerAffiliated withCenter for Primary Care and Department of Internal Medicine, University of Rochester School of Medicine and Dentistry
  • , John D. BisognanoAffiliated withDepartment of Medicine, Division Cardiology, University of Rochester School of Medicine and Dentistry
  • , Robert J. FortunaAffiliated withCenter for Primary Care and Department of Internal Medicine, University of Rochester School of Medicine and Dentistry

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ABSTRACT

BACKGROUND

The United States Preventive Services Task Force (USPSTF) released updated guidelines in 2009 recommending aspirin to prevent myocardial infarction among at-risk men and stroke among at-risk women.

OBJECTIVE

Our aim was to examine clinician aspirin recommendation among eligible persons based on cardiovascular risk scores and USPSTF cutoffs.

DESIGN

We used across-sectional analysis of a current nationally representative sample.

PARTICIPANTS

Participants were aged 40 years and older, and in the National Health and Nutrition Examination Survey (NHANES) (2011–2012).

MAIN MEASURES

We determined aspirin eligibility for cardiovascular disease (CVD) prevention for each participant based on reported and assessed cardiovascular risk factors. We assessed men’s risk using a published coronary heart disease risk calculator based on Framingham equations, and used a similar calculator for stroke to assess risk for women. We applied the USPSTF risk cutoffs for sex and age that account for offsetting risk for gastrointestinal hemorrhage. We assessed clinician recommendation for aspirin based on participant report.

RESULTS

Among men 45–79 years and women 55–79 years, 87 % of men and 16 % of women were potentially eligible for primary CVD aspirin prevention. Clinician recommendation rates for aspirin among those eligible were low, 34 % for men and 42 % for women. Rates were highest among diabetics (63 %), those 65 to 79 years (52 %) or those in poor health (44 %). In contrast, aspirin recommendation rates were 76 % for CVD secondary prevention. After accounting for patient factors, particularly age, eligibility for aspirin prevention was not significantly associated with receiving a clinician’s recommendation for aspirin (AOR 0.99 %; CI 0.7–1.4).

CONCLUSIONS

Despite an “A recommendation” from the USPSTF for aspirin for primary prevention of CVD, the majority of men and women potentially eligible for aspirin did not recall a clinical recommendation from their clinician.

KEY WORDS

aspirin primary CVD prevention USPSTF guidelines