Chipalkatti Naina, Barnes Geoffrey D, Bashaw Linda, Davie Adam, Griggs Jennifer J, Harrod Molly, Kurlander Jacob E, Medaugh Christine, Packard Rebeca, Powell Corey, Sood Suman, Spranger Elizabeth, Vordenberg Sarah E, Schaefer Jordan K
Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Blood Adv. 2024 Dec 24;8(24):6207-6214. doi: 10.1182/bloodadvances.2024014220.
Recent guidelines have recommended a reduced role for primary prevention aspirin use, which is associated with an increased bleeding risk. This study aimed to characterize guideline-discordant aspirin use among adults in a community care setting. As part of a quality improvement initiative, patients at 1 internal medicine and 1 family medicine clinic affiliated with an academic hospital were sent an electronic survey. Patients were included if they were at least 40 years old, had a primary care provider at the specified site, and were seen in the last year. Patients were excluded if they had an indication for aspirin other than primary prevention. Responses were collected from 15 February to 16 March 2022. Analyses were performed to identify predictors of primary prevention aspirin use and predictors of guideline-discordant aspirin use; aspirin users and nonusers were compared using Fisher exact test, independent samples t tests, and multivariable logistic regression. Of the 1460 patients sent a survey, 668 (45.8%) responded. Of the respondents, 132 (24.1%) reported aspirin use that was confirmed to be for primary prevention. Overall, 46.2% to 58.3% of primary prevention aspirin users were potentially taking aspirin, contrary to the guideline recommendations. Predictors of discordant aspirin use included a history of diabetes mellitus and medication initiation by a primary care provider. In conclusion, primary prevention aspirin use may be overutilized and discordant with recent guideline recommendations for approximately half of the patients, suggesting a need for aspirin deimplementation. These efforts may be best focused at the primary care level.
近期指南建议减少用于一级预防的阿司匹林使用，因为其会增加出血风险。本研究旨在描述社区护理环境中成年人不符合指南的阿司匹林使用情况。作为质量改进计划的一部分，向一家学术医院附属的1家内科诊所和1家家庭医学诊所的患者发送了电子调查问卷。纳入标准为年龄至少40岁、在指定地点有初级保健提供者且在过去一年中曾就诊的患者。有除一级预防之外的阿司匹林使用指征的患者被排除。于2022年2月15日至3月16日收集回复。进行分析以确定一级预防阿司匹林使用的预测因素和不符合指南的阿司匹林使用的预测因素；使用Fisher精确检验、独立样本t检验和多变量逻辑回归对阿司匹林使用者和非使用者进行比较。在1460名收到调查问卷的患者中，668名（45.8%）回复。在回复者中，132名（24.1%）报告使用阿司匹林且被确认为用于一级预防。总体而言，46.2%至58.3%的一级预防阿司匹林使用者可能正在服用阿司匹林，这与指南建议相悖。不符合指南的阿司匹林使用的预测因素包括糖尿病病史和由初级保健提供者开始用药。总之，一级预防阿司匹林的使用可能存在过度使用情况，约一半患者与近期指南建议不一致，这表明需要减少阿司匹林的使用。这些努力可能最好集中在初级保健层面。
