Background--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. Methods and Results--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. Conclusions--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.
Bibliographical noteFunding Information:
This study used a conservative 10-year CVD risk score of 10% as the threshold to define the intermediate-risk group. This risk score threshold is supported by the recently updated USPSTF recommendation statement, which uses a 10-year CVD risk score of ≥10% as the cutoff for PP aspirin recommendation in adults aged 50 to 59 years (B recommendation) and those aged 60 to 69 years (C recommendation). Future evaluation of PP aspirin use following the 2016 recommendations can be informed by these data as clinicians and researchers seek to use these guidelines to achieve maximal benefit at lowest risk.
Dr Hirsch earned income from serving on a steering committee for an unrelated clinical trial sponsored by Bayer, which has no relationship to this research project. This relationship had been reviewed and managed by the University of Minnesota in accordance with its conflict of interest policies. No other authors report a conflict of interest related to this study.
Philanthropic funding was provided from the Lillehei Heart Institute, University of Minnesota, and a grant from the National Heart, Lung, and Blood Institute (1R01HL126041-01).
© 2017 The Authors.
- Cardiovascular disease
- Risk score
- US Preventive Services Task Force