Frequency and Practice-Level Variation in Inappropriate Aspirin Use for the Primary Prevention of Cardiovascular Disease: Insights From the National Cardiovascular Disease Registry’s Practice Innovation and Clinical Excellence Registry | Journal Scan
What is the frequency and practice-level variation in inappropriate aspirin use for primary prevention?
The authors assessed appropriateness of aspirin use among 68,808 unique patients receiving aspirin for primary prevention from 119 US practices participating in the National Cardiovascular Data Registry (NCDR) Practice Innovation and Clinical Excellence (PINNACLE) Registry. Inappropriate aspirin use for primary prevention was defined as aspirin use in those with 10-year cardiovascular disease risk <6%.
Inappropriate aspirin use frequency was 11.6% in the overall cohort. There was significant practice-level variation in inappropriate use (range 0-71.8%, median 10.1%, interquartile range 6.4%) for practices; adjusted median rate ratio 1.63 (95% confidence interval, 1.47-1.77). Results remained consistent after excluding women over 65 years of age and after excluding patients with diabetes.
A large number of patients in this national registry receive inappropriate aspirin therapy for primary prevention, with significant practice-level variation.
The utility of aspirin for primary prevention among patients with adequate risk factor control is contentious, and the guideline recommendation of using calculated risk to assess patient candidacy for aspirin has not been proven in randomized trials. Further, the risk calculators themselves have moderate discrimination and lack the precision that guideline support seems to imply. The variation in practice demonstrated in this study should not come as a surprise since it is unclear who, if anyone, benefits from primary prevention with aspirin once smoking, lipids, and hypertension are under control. The results of the ongoing large randomized trials (ARRIVE, ASPREE, and ASCEND) will help provide clarity to this field over the next few years.
Keywords: Aspirin, Confidence Intervals, Diabetes Mellitus, Hypertension, Lipids, Primary Prevention, Registries, Risk, Risk Factors, Smoking
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