Malayala Srikrishna Varun, Raza Ambreen
Department of Hospital Medicine, Jeanes Hospital, Temple University Health System, Philadelphia, PA, USA.
Department of Infectious Diseases, Cooper University, Camden, NJ, USA.
Int J Clin Pract. 2016 Nov;70(11):898-906. doi: 10.1111/ijcp.12869. Epub 2016 Sep 12.
In 2009, United States Preventive Services Taskforce (USPSTF) recommends aspirin (ASA) for men aged 45-79 years when the benefit of coronary artery disease (CAD) risk reduction outweighs the harm of gastrointestinal haemorrhage. Our objective is to evaluate compliance with this USPSTF recommendation.
This study is a cross-sectional study and 2011-2012 National Health and Nutrition Examination Survey (NHANES) dataset was used for this study. Out of the available sample, 1155 (11.8%) had the inclusion criteria (men aged 45-79 years, no prior history of CAD). The participants' 10-year Framingham risk score for developing CAD was calculated to identify the people who meet criteria to take aspirin. The population characteristics that influence the physicians' decision to prescribe aspirin and the characteristics those influence the participants' compliance with doctor's advice to take aspirin were identified.
Almost 91.5% qualified for aspirin intake. About 65% (595/916) of them were not advised by their providers to take aspirin. Among the 321 who were prescribed aspirin, 30% (96/321) were non-compliant and 1.2% (4/321) discontinued aspirin because of side effects. In the group that did not qualify for aspirin, 37.6% (32/85) were inappropriately prescribed aspirin out of which 78.1% (25/32) were actually taking it. Younger age and lesser comorbidities were significantly associated with under prescription by physicians (P < .001) and lower compliance by participants (P < .001).
In April 2016, USPSTF updated the recommendations regarding benefits of aspirin. Our study evaluates the factors that influenced the compliance with the 2009 recommendations. This study highlights the challenges that the 2016 guidelines might have to face.
2009年，美国预防服务工作组（USPSTF）建议，对于45 - 79岁男性，当降低冠状动脉疾病（CAD）风险的益处超过胃肠道出血危害时，可服用阿司匹林（ASA）。我们的目的是评估对这一USPSTF建议的依从性。
本研究为横断面研究，使用2011 - 2012年国家健康与营养检查调查（NHANES）数据集。在可用样本中，1155名（11.8%）符合纳入标准（45 - 79岁男性，无CAD病史）。计算参与者患CAD的10年弗雷明汉风险评分，以确定符合服用阿司匹林标准的人群。确定影响医生开具阿司匹林处方决定的人群特征以及影响参与者遵医嘱服用阿司匹林的特征。
近91.5%的人符合服用阿司匹林的条件。其中约65%（595/916）未得到医生的服用阿司匹林建议。在321名被开具阿司匹林处方的人中，30%（96/321）未遵医嘱，1.2%（4/321）因副作用停用阿司匹林。在不符合服用阿司匹林条件的人群中，37.6%（32/85）被不恰当地开具了阿司匹林，其中78.1%（25/32）实际在服用。年龄较小和合并症较少与医生处方不足（P <.001）以及参与者依从性较低（P <.001）显著相关。
2016年4月，USPSTF更新了关于阿司匹林益处的建议。我们的研究评估了影响对2009年建议依从性的因素。本研究突出了2016年指南可能面临的挑战。
