Underutilization of Aspirin Persists in US Ambulatory Care for the Secondary and Primary Prevention of Cardiovascular Disease

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While these data limitations present certain difficulties in interpreting the absolute usage of aspirin, they should have limited impact on our trend analysis. The extent of under-reporting may have attenuated over time due to increased awareness of its effectiveness in cardiovascular risk reduction, which could partly explain the increasing trends in use that we observed. We have no reason to believe that under-reporting varies so substantially by patient visit characteristics that it could have confounded our multivariate logistic analysis.

In conclusion, improvements in aspirin use for reducing risks of CVD among US outpatients are at best modest, and substantial treatment gaps persist, particularly in secondary prevention, for which definitive evidence of benefits is available.Aspirin is more underused than statins despite its more favorable cost-effectiveness. Marked changes in clinical practice are unlikely to occur unless more aggressive, innovative means are implemented to enhance healthcare provider and patient adherence to consensus guidelines on aspirin therapy to prevent CVD events. In particular, targeted interventions may be warranted in patient subpopulations in which aspirin use is lower than average, including women,young adults, and ethnic minorities.Targeted continuing medical education for primary care providers, especially in solo or small-group practices, may introduce greater consistency into practice by specialty and practice setting.Ôûá

Acknowledgments

This research was sponsored by an unrestricted grant from Bayer Pharmaceutical Corporation. Additional support was provided by a research award from the Agency for Healthcare Research and Quality (R01-HS11313). Both funding sources had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests

The authors have declared that no competing interests exist.

Author Contributions

RSS obtained study funding. RSS and JM designed the study. RSS, VM, and JM analyzed the data and contributed to writing the paper.

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