Cardiovascular Division and Lillehei Heart Institute University of Minnesota Medical School, Minneapolis, MN
Cardiovascular Division and Lillehei Heart Institute University of Minnesota Medical School, Minneapolis, MN.
J Am Heart Assoc. 2017 Oct 3;6(10):e006328. doi: 10.1161/JAHA.117.006328.
No previous study has evaluated the impact of past US Preventive Services Task Force statements on primary prevention (PP) aspirin use in a primary care setting. The aim of this study was to evaluate temporal changes in PP aspirin use in a primary care population, stratifying patients by their 10-year global cardiovascular disease risk, in response to the 2009 statement.
This study estimated biannual aspirin use prevalence using electronic health record data from primary care clinics within the Fairview Health System (Minnesota) from 2007 to 2015. A total of 94 270 patient encounters had complete data to estimate a 10-year cardiovascular disease risk score using the 2013 American College of Cardiology/American Heart Association global risk estimator. Patients were stratified into low- (<10%), intermediate- (10-20%), and high- (≥20%) risk groups. Over the 9-year period, PP aspirin use averaged 43%. When stratified by low, intermediate and high risk, average PP aspirin use was 41%, 63%, and 73%, respectively. Average PP aspirin use decreased after the publication of the 2009 US Preventive Services Task Force recommendation statement: from 45% to 40% in the low-risk group; from 66% to 62% in the intermediate-risk group; and from 76% to 73% in the high-risk group, before and after the guideline.
Publication of the 2009 US Preventive Services Task Force recommendation was not associated with an increase in aspirin use. High risk PP patients utilized aspirin at high rates. Patients at intermediate risk were less intensively treated, and patients at low risk used aspirin at relatively high rates. These data may inform future aspirin guideline dissemination.
之前的研究尚未评估美国预防服务工作组过去的声明对初级预防（PP）阿司匹林在初级保健环境中的使用的影响。本研究的目的是评估在 2009 年的声明之后，心血管疾病 10 年全球风险分层的初级保健人群中，PP 阿司匹林的使用随时间的变化。
本研究使用明尼苏达州费尔维尤健康系统（Fairview Health System）的初级保健诊所的电子健康记录数据，估计了 2007 年至 2015 年每两年一次的阿司匹林使用率。共有 94070 例患者的就诊记录具有完整数据，可以使用 2013 年美国心脏病学会/美国心脏协会的全球风险估计器来估计 10 年心血管疾病风险评分。患者被分为低风险（<10%）、中风险（10-20%）和高风险（≥20%）组。在 9 年期间，PP 阿司匹林使用率平均为 43%。按照低、中、高风险分层，平均 PP 阿司匹林使用率分别为 41%、63%和 73%。在 2009 年美国预防服务工作组推荐声明发布后，PP 阿司匹林的使用率下降：低风险组从 45%降至 40%；中风险组从 66%降至 62%；高风险组从 76%降至 73%，在指南发布之前和之后。
2009 年美国预防服务工作组推荐声明的发布与阿司匹林使用率的增加无关。高危 PP 患者大量使用阿司匹林。中危患者的治疗强度较低，低危患者的阿司匹林使用率相对较高。这些数据可能为未来的阿司匹林指南传播提供信息。
