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A survey of internists’ recommendations for aspirin in older adults and barriers to evidence-based use

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Abstract

Recent trials suggest that aspirin for primary prevention may do more harm than good for some, including adults over 70 years of age. We sought to assess how primary care providers (PCPs) use aspirin for the primary prevention in older patients and to identify barriers to use according to recent guidelines, which recommend against routine use in patients over age 70. We surveyed PCPs about whether they would recommend aspirin in clinical vignettes of a 75-year-old patient with a 10-year atherosclerotic cardiovascular disease risk of 25%. We also queried perceived difficulty following guideline recommendations, as well as perceived barriers and facilitators. We obtained responses from 372 PCPs (47.9% response). In the patient vignette, 45.4% of clinicians recommended aspirin use, which did not vary by whether the patient was using aspirin initially (p = 0.21); 41.7% believed aspirin was beneficial. Perceived barriers to guideline-based aspirin use included concern about patients being upset (41.6%), possible malpractice claims (25.0%), and not having a strategy for discussing aspirin use (24.5%). The estimated adjusted probability of rating the guideline as “hard to follow” was higher in clinicians who believed aspirin was beneficial (29.4% vs. 8.0%; p < 0.001) and who worried the patient would be upset if told to stop aspirin (26.7% vs. 12.5%; p = 0.001). Internists vary considerably in their recommendations for aspirin use for primary prevention in older patients. A high proportion of PCPs continue to believe aspirin is beneficial in this setting. These results can inform de-implementation efforts to optimize evidence-based aspirin use.

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Funding

This study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases through a K23 award (K23DK118179) (JEK).

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, C366 Med Inn Building, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA

    Jordan K. Schaefer

  2. Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA

    Geoffrey D. Barnes

  3. Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, MI, USA

    Jeremy B. Sussman & Brian J. Zikmund-Fisher

  4. Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA

    Jeremy B. Sussman, Sameer D. Saini, Tanner J. Caverly & Jacob E. Kurlander

  5. Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA

    Tanner J. Caverly

  6. Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA

    Sameer D. Saini, Tanner J. Caverly & Jacob E. Kurlander

  7. Research Center, American College of Physicians, Philadelphia, PA, USA

    Susan Read

  8. Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA

    Brian J. Zikmund-Fisher

  9. Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA

    Brian J. Zikmund-Fisher

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  1. Jordan K. Schaefer
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Contributions

GDB and JEK acquired the data; GDB, JEK, JBS, and SDS conceived the study, while GEB, JKS, TJC, and JEK designed the study. JEK had full access to all of the data in the study and takes responsibility for the integrity of the data; JKS and JEK takes responsibility for the accuracy of the data analysis. JKS drafted the article. All the authors were involved in the writing and editing of the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Jordan K. Schaefer.

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Conflict of interest

Dr Barnes reports personal fees from Pfizer/Bristol Myer Squibb, Janssen, Acelis Connected Health, and serves on the board of directors for the Anticoagulation Forum. The remaining authors have nothing to disclose related to this project.

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Schaefer, J.K., Barnes, G.D., Sussman, J.B. et al. A survey of internists’ recommendations for aspirin in older adults and barriers to evidence-based use. J Thromb Thrombolysis 54, 639–646 (2022). https://doi.org/10.1007/s11239-022-02669-7

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