JIJITANG2014-09-27 4:38 PM

WHY DON’T MORE DOCS TELL HEART PATIENTS TO TAKE ASPIRIN?

There’s evidence a daily low dose of aspirin can protect against cardiovascular disease, but the people who could most benefit from the medication may not be taking it.


A new study shows that only 40 percent of people who are at high risk of cardiovascular disease say their doctor has recommended aspirin therapy, while one-quarter of people at low risk report their doctors told them to take the drug.


The US Preventive Services Task Force, a panel of national experts in prevention and evidence-based medicine, recommends aspirin use to prevent heart attack and stroke in men age 45 to 79 and women age 55 to 79 when the benefit outweighs the risk of gastrointestinal bleeding, a possible side effect of regular aspirin use.


“Cardiovascular disease is a significant problem in the United States and the appropriate use of prevention strategies is particularly important,” says Arch G. Mainous III, the study’s lead investigator and chair of the health services research, management, and policy department at University of Florida.


THE ‘RIGHT’ PATIENTS

“Aspirin has been advocated as a prevention strategy but only for certain patients. There are health risks associated with the treatment. It is important that doctors are directing the right patients to get aspirin for cardiovascular disease prevention.”


Other studies have examined whether people at risk of heart attack or stroke were taking aspirin, but the new study, published in the Journal of the American Heart Association, is the first to explore whether a person had received a doctor’s recommendation for aspirin.


Researchers analyzed data from the National Health and Nutrition Examination Survey 2011-2012, a large, nationally representative survey that combines survey questions with laboratory testing.


About 3,500 participants over age 40 were asked if their doctor had recommended they take low-dose aspirin for the prevention of cardiovascular disease, stroke, or cancer. If they had received the recommendation, participants were also asked if they were following their doctor’s advice.


MISSED OPPORTUNITIES

Individuals’ survey responses were then compared to their Framingham Risk Score, a risk assessment tool for determining a person’s 10-year risk of having a heart attack. The tool calculates a score based on a person’s age, gender, total and HDL cholesterol, smoking status, and blood pressure. People who had a 10-year risk score of more than 10 percent were classified as high risk, while patients with less than a 10 percent risk were classified as low risk.


“The results indicated that more than half of the patients who should have been recommended to take aspirin did not report being told by their health care provider to take aspirin,” Mainous says. “Further, a substantial proportion of those not at increased risk for cardiovascular disease were recommended to take aspirin.


“The vast majority of patients who reported being told to take aspirin were complying with their doctor’s advice. The issue that was concerning to us wasn’t adherence to treatment, but whether the right patients were being given advice on aspirin treatment appropriate for them.”


Future research should evaluate whether making Framingham Risk Score computations available through electronic medical records would help doctors make accurate decisions about who should take low-dose aspirin.


Original Article:

Use of Aspirin for Primary and Secondary Cardiovascular Disease Prevention in the United States, 2011–2012, Published on Journal 《Journal of American Heart Association》in Jun 9, 2014.

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