Fiscella Kevin, Winters Paul C, Mendoza Michael, Noronha Gary J, Swanger Carlos M, Bisognano John D, Fortuna Robert J
Department of Family Medicine, University of Rochester School of Medicine and Dentistry, 1381 South Avenue, Rochester, NY, 14620, USA,
J Gen Intern Med. 2015 Feb;30(2):155-60. doi: 10.1007/s11606-014-2985-8.
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.
Our aim was to examine clinician aspirin recommendation among eligible persons based on cardiovascular risk scores and USPSTF cutoffs.
We used across-sectional analysis of a current nationally representative sample.
Participants were aged 40 years and older, and in the National Health and Nutrition Examination Survey (NHANES) (2011-2012).
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.
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).
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.
美国预防服务工作组（USPSTF）于2009年发布了更新指南，建议使用阿司匹林预防高危男性心肌梗死及高危女性中风。
我们的目的是根据心血管风险评分和USPSTF临界值，研究符合条件的人群中临床医生对阿司匹林的推荐情况。
我们对当前具有全国代表性的样本进行了横断面分析。
参与者年龄在40岁及以上，来自2011 - 2012年的国家健康与营养检查调查（NHANES）。
我们根据报告和评估的心血管危险因素，确定每位参与者预防心血管疾病（CVD）使用阿司匹林的 eligibility。我们使用基于弗雷明汉方程的已发表冠心病风险计算器评估男性风险，并使用类似的中风风险计算器评估女性风险。我们应用了考虑到胃肠道出血抵消风险的USPSTF性别和年龄风险临界值。我们根据参与者报告评估临床医生对阿司匹林的推荐情况。
在45 - 79岁的男性和55 - 79岁的女性中，87%的男性和16%的女性可能符合CVD一级预防使用阿司匹林的条件。符合条件者中临床医生对阿司匹林的推荐率较低，男性为34%，女性为42%。糖尿病患者（63%）、65至79岁者（52%）或健康状况较差者（44%）的推荐率最高。相比之下，CVD二级预防的阿司匹林推荐率为76%。在考虑患者因素，特别是年龄后，阿司匹林预防的eligibility与获得临床医生对阿司匹林的推荐无显著关联（比值比0.99%；可信区间0.7 - 1.4）。
尽管USPSTF对阿司匹林用于CVD一级预防给出了“A类推荐”，但大多数可能符合使用阿司匹林条件的男性和女性并未回忆起临床医生给出过相关推荐
