Background:
Aspirin is beneficial for reducing the incidence of myocardial infarctions and ischemic strokes and has been recommended by United States Preventive Services Task Force (USPSTF) as a primary prevention strategy for men above the age of 45 years and women above the age of 55 years until the age of 80. This study was intended to evaluate the use of aspirin as a discharge medication for primary prevention in patients who have been assessed for cardiovascular risk in hospital.
Methods:
Data was collected prospectively over a period of six successive months from 250 consecutive patients who were admitted with chest pain without a history of coronary artery disease and had their cardiovascular risk assessed in hospital by means of patient history, physical exam, laboratory work and a stress test. Inclusion criteria included age within the USPSTF recommendations, not taking aspirin at the time of admission, a 10 year coronary heart disease risk and 10 year stroke risk greater than the risk of bleeding from the use of aspirin. Exclusion criteria included existing indication for aspirin use, contraindication to its use including documented allergy and already on other antiplatelet agents or anticoagulants. Predictors of discharge on aspirin where assessed with Logistic Regression. Statistical significance was determined at p ≤ 0.05. Data analysis was performed using SPSS 18.0
®
(SPSS, Inc., Chicago, IL).
Results:
Of the 250 patients, 120 patients fulfilled the existing recommendations for the use of aspirin for primary prevention as per USPSTF guidelines. Amongst the study population, 57.9% (33 of 57) men and only 42.9% (27 of 63) of the women were discharged home on aspirin. Having diabetes (OR 3.87; CI 1.39 - 10.77; p=0.01) and being older (OR 0.93; CI 0.87 - 0.89; p=0.003) played a significant role in being discharged on aspirin when using multivariate analysis. However a specific cut off age was not discernible. Amongst women, apart from diabetes (OR 7.85; CI 1.26 - 49.1; p=0.028) and age (OR 0.83; CI 0.74 - 0.93; p=0.002) with elderly patients more likely to be discharged on aspirin, hypertension (OR 4.16; CI 1.04 - 16.7; p=0.044) also played a significant role under multivariate analysis. Other factors including dyslipidemia, family history of cardiovascular disease, tobacco use and racial differences did not play a significant role.There were no such clinical predictors for men that was statistically significant.
Conclusion:
Aspirin is being under-utilized as part of primary prevention strategy. The presence of diabetes and an elderly patient often prompts a recommendation for aspirin use. A conscious effort should be made by hospital based care providers to ensure that the appropriate preventive strategies are part of their discharge medication list.
The effectiveness and cost-effectiveness of plant sterol or stanol-enriched functional foods as a primary prevention strategy for people with cardiovascular disease risk in England: a modeling study
