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Research ArticleOriginal Research

Effects of Changing Guidelines on Prescribing Aspirin for Primary Prevention of Cardiovascular Events

Jennifer Hissett, Brittany Folks, Letoynia Coombs, William LeBlanc and Wilson D. Pace
The Journal of the American Board of Family Medicine January 2014, 27 (1) 78-86; DOI: https://doi.org/10.3122/jabfm.2014.01.130030
Jennifer Hissett
From the Louisiana State University Emergency Medicine Residency, New Orleans (JH); the Exempla St. Joseph Hospital Internal Medicine Residency, Denver, CO (BF); and the Department of Family Medicine, University of Colorado School of Medicine, Aurora (LC, WL, WDP).
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Brittany Folks
From the Louisiana State University Emergency Medicine Residency, New Orleans (JH); the Exempla St. Joseph Hospital Internal Medicine Residency, Denver, CO (BF); and the Department of Family Medicine, University of Colorado School of Medicine, Aurora (LC, WL, WDP).
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Letoynia Coombs
From the Louisiana State University Emergency Medicine Residency, New Orleans (JH); the Exempla St. Joseph Hospital Internal Medicine Residency, Denver, CO (BF); and the Department of Family Medicine, University of Colorado School of Medicine, Aurora (LC, WL, WDP).
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William LeBlanc
From the Louisiana State University Emergency Medicine Residency, New Orleans (JH); the Exempla St. Joseph Hospital Internal Medicine Residency, Denver, CO (BF); and the Department of Family Medicine, University of Colorado School of Medicine, Aurora (LC, WL, WDP).
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Wilson D. Pace
From the Louisiana State University Emergency Medicine Residency, New Orleans (JH); the Exempla St. Joseph Hospital Internal Medicine Residency, Denver, CO (BF); and the Department of Family Medicine, University of Colorado School of Medicine, Aurora (LC, WL, WDP).
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Article Figures & Data

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    Figure 1.

    Percentage of all patients recorded as receiving aspirin therapy. AA, aortic aneurysm; CKD, chronic kidney disease; CVD, cardiovascular disease; DM, diabetes mellitus; HLD, hyperlipidemia; HTN, hypertension; PVD, peripheral vascular disease.

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    Figure 2.

    Percentage of patients with current cardiovascular disease (CVD) who are taking aspirin (ASA) versus patients with newly diagnosed CVD who were prescribed ASA within the first year of diagnosis.

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    Figure 3.

    Percentage of all patients prescribed aspirin within 1 year of new diagnosis. Arrows indicate corresponding time of study publication or guideline change. AA, aortic aneurysm; ADA, American Diabetes Association; AHA, American Heart Association; ATTC, Antithrombotic Trialists' Collaboration; CKD, chronic kidney disease; CVD, cardiovascular disease; DM, diabetes mellitus; DOPPS, Dialysis Outcomes and Practice Patterns Study; HLD, hyperlipidemia; HTN, hypertension; JPAD, Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes; POPADAD, Prevention of Progression of Arterial Disease and Diabetes Trial; PVD, peripheral vascular disease.

Tables

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    Table 1. Distribution of Cohort by Sex, Age (with Standard Deviation [SD]), and Diagnosis
    DiagnosisTotal (n)MaleFemale
    Patients (n)Age, years (SD)Patients (n)Age, years (SD)
    Cardiovascular disease13,6397,81768.8 (12.2)5,81671.4 (13.7)
    Diabetes25,29312,78059.7 (14.3)12,50961.3 (15.1)
    Chronic kidney disease4,3042,35168.2 (14.4)1,95271.1 (15.0)
    Peripheral vascular disease4,2661,87167.8 (13.6)2,39563.6 (17.9)
    Aortic aneurysm95266371.8 (12.1)28972.7 (14.5)
    Hyperlipidemia94,53850,35055.0 (13.9)44,16959.1 (14.6)
    Hypertension74,85035,95258.4 (14.3)38,88262.2 (14.7)
    Total131,05066,32755.1 (14.4)64,69958.6 (15.2)
    • View popup
    Table 2. Total Number of Patients in Observed Practices Diagnosed with Both New and Current Disease, Correlating to Time Periods and Number (%) Taking Aspirin
    Aspirin Use by DiseaseJanuary-December 2007January-December 2008January 2009 to May 2010June 2010 to May 2011
    New DiagnosisCurrent DiseaseNew DiagnosisCurrent DiseaseNew DiagnosisCurrent DiseaseNew DiagnosisCurrent Disease
    Cardiovascular disease
        Total, n2,89012,6662,90615,5724,69220,2642,25622,520
        Patients taking aspirin, n (%)1,159 (40.1)4,840 (38.2)1,159 (39.9)5,999 (38.5)1,944 (41.4)7,943 (39.2)938 (41.6)8,881 (39.4)
    Diabetes
        Total, n2,90411,3432,50913,8524,72218,5742,35520,929
        Patients taking aspirin, n (%)822 (28.3)2,988 (26.3)712 (28.4)3,700 (26.7)1,570 (33.2)5,270 (28.4)838 (35.6)6,108 (29.2)
    Chronic kidney disease
        Total, n4141,0964641,5608642,4244852,909
        Patients taking aspirin, n (%)151 (36.5)380 (34.7)168 (36.2)548 (35.1)326 (37.7)874 (36.1)192 (39.6)1,066 (36.6)
    Peripheral vascular disease
        Total, n4911,4946312,1259833,1083853,493
        Patients taking aspirin, n (%)174 (35.4)521 (34.9)230 (36.5)751 (35.3)365 (37.1)1,116 (35.9)156 (40.5)1,272 (36.4)
    Hyperlipidemia
        Total, n11,77342,04111,86353,90420,43974,34310,07584,418
        Patients taking aspirin, n (%)1,998 (17.0)6,976 (16.6)1,816 (15.3)8,792 (16.3)4,121 (20.2)12,913 (17.4)2,472 (24.5)15,385 (18.2)
    Hypertension
        Total, n853635,7328,17543,90714,40958,3167,06665,382
        Patients taking aspirin, n (%)1689 (19.8)6,321 (17.7)1,500 (18.3)7,821 (17.8)3,366 (23.4)11,187 (19.2)2,020 (28.6)13,207 (20.2)
    • View popup
    Table 3. Total Number of Patients Diagnosed with Both New and Current Disease and Taking Aspirin Therapy
    DiseaseJanuary-December 2007January-December 2008January 2009 to May 2010June 2010 to May 2011
    New DiagnosisCurrent DiseaseNew DiagnosisCurrent DiseaseNew DiagnosisCurrent DiseaseNew DiagnosisCurrent Disease
    Cardiovascular disease1,1594,8401,1595,9991,9447,9439388,881
    Diabetes8222,9887123,7001,5705,2708386,108
    Chronic kidney disease1513801685483268741921,066
    Peripheral vascular disease and aortic aneurysm1745212307513651,1161561,272
    Hyperlipidemia1,9986,9761,8168,7924,12112,9132,47215,385
    Hypertension1,6896,3211,5007,8213,36611,1872,02013,207
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The Journal of the American Board of Family     Medicine: 27 (1)
The Journal of the American Board of Family Medicine
Vol. 27, Issue 1
January-February 2014
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Effects of Changing Guidelines on Prescribing Aspirin for Primary Prevention of Cardiovascular Events
Jennifer Hissett, Brittany Folks, Letoynia Coombs, William LeBlanc, Wilson D. Pace
The Journal of the American Board of Family Medicine Jan 2014, 27 (1) 78-86; DOI: 10.3122/jabfm.2014.01.130030

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Effects of Changing Guidelines on Prescribing Aspirin for Primary Prevention of Cardiovascular Events
Jennifer Hissett, Brittany Folks, Letoynia Coombs, William LeBlanc, Wilson D. Pace
The Journal of the American Board of Family Medicine Jan 2014, 27 (1) 78-86; DOI: 10.3122/jabfm.2014.01.130030
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