A Survey of Aspirin Use in Americans: The Key Role of Physician Advice

Led by Craig Williams, PharmD, the Council on Aspirin for Health and Prevention (Council), recently conducted a national survey of U.S. adults on aspirin use to update a previous survey conducted in 2007. In August 2012, 2,509 adults aged 45-79 were asked about their current aspirin use, their knowledge of aspirin’s benefits and harms, and whether they discussed taking aspirin with a health care provider. The survey data were analyzed to find out which factors most influence a person’s decision to take aspirin. Of those without a history of cardiovascular disease, 47% reported using aspirin. Aspirin use was more common if risk factors for heart attacks and stroke were present. In addition, those surveyed were more likely to use aspirin if they were more knowledgeable about aspirin’s benefits and harms and if they had discussed aspirin use with their health care providers. 

The Risks of Daily Aspirin Use for Cardiovascular Prevention - Myth or Reality?

This research project was executed by Dr. Miser and Dr. Stafford. Its purpose was to assess adverse events from daily aspirin use for primary and secondary prevention of CVD in an adult family practice population.  This was a cross-sectional study in five community family practice offices surrounding a large midwestern city. The participants consisted of a convenience sample of 1,605 adults, men age 45-79 and women age 55-79 years, visiting their family physician. The instrument was an anonymous 22-item pre-tested questionnaire and medical record review. The study authors concluded that although daily aspirin use has been proven useful in preventing cardiovascular disease, there is a risk of adverse reactions in about 1 in 10 adults. Thus, as family physicians provide counseling regarding appropriate aspirin use, it is important to identify those who may be at increased risk for an adverse reaction to aspirin.

Why Does Aspirin Use Fall Short of Recommendations?

Dr. Miser studies the delivery of primary care prevention services. He conducted a detailed clinical survey of aspirin use in five family medicine practices in the Ohio State University Primary Care Network in central Ohio. A total of 1,615 subjects, age 40 to 79 years, completed a 22-item, self-administered, anonymous survey concerning their demographics, medical history, cardiac risk factors, patterns of aspirin use and interactions with health providers about aspirin. This sample had a mean age 55 years. Of all respondents, 63% were women, 66% were white and 28% were African-American. Of those with known cardiovascular disease, 67% were taking daily aspirin. Of those without cardiovascular disease, 31% were taking daily aspirin. The most common reasons for not taking daily aspirin were that no one recommended it (32%), already taking too many medications (13%), concern about interactions (9%), bleeding problems (8%), and aspirin allergy (5%). The survey showed that discussions between patients and clinicians about aspirin were key to patient decisions to start aspirin.

Including Cancer Benefits Would Expand Population That Is Eligible to Take Aspirin

Dr. Pignone conducts modeling work to determine the effects of aspirin on different health outcomes. He recently published an article on how cancer mortality affects the cost-effectiveness of using aspirin to prevent first heart attacks in men.1 Modeling a hypothetical population of middle aged men without diabetes or heart disease who were given aspirin therapy, he estimated their decreased risk of cardiovascular disease and cancer compared with the increased risk of gastrointestinal bleeding and stroke. He used quality-adjusted life years (adjusting for less quality following events like heart attacks) and 2012 U.S. dollars as the units of disease burden and cost. Accounting for both cardiovascular and cancer prevention benefits, aspirin was cost-effective for middle aged men with a 10-year chance of developing cardiovascular disease as low as 2.5% (half the rate compared to not accounting for cancer benefits). This expanded the population where aspirin benefits exceeded harms. This analysis suggests that aspirin recommendation should not be based solely on cardiovascular disease, as in current federal guidelines, but rather should incorporate cancer prevention.

An Online Tool for Aspirin Advice

Dr. Stafford has developed an online tool that advises consumers about whether aspirin is right for them and facilitates patient-provider discussions about aspirin. It was pilot tested among Stanford University employees.2 Data collected through the online tool showed that of patients without past stroke or heart attack who were most likely to benefit from aspirin, only 56% were taking aspirin. Of those with little to gain from aspirin, 11% were nonetheless taking aspirin. The tool advised users to contact their health care providers, particularly when the recommendation for use was different from their current practices.

Medicare Coverage for Doctors Giving Aspirin Advice

Dr. Stafford and his Stanford University colleague, Dr. Veronica Yank, developed a formal, evidence-based request to the U.S. Center on Medicare and Medicaid Services (CMS). This request led to federal adoption of a new payment mechanism so that physicians can be reimbursed for intensive heart disease and stroke risk factor counseling provided to their Medicare patients.

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