Study Shows Many Veterans Unnecessarily Take Low-Dose Aspirin to Prevent Cardiovascular Disease
Although many people take low-dose aspirin to prevent atherosclerotic cardiovascular disease (ASCVD), it also is associated with harm. In recognition of recent findings that found greater risk of internal hemorrhage than previously demonstrated, the American College of Cardiology and American Heart Association (ACC/AHA) narrowed their aspirin use recommendations for the primary prevention of ASCVD. While 96% of hospitals have an electronic health record (EHR), the practicality of using electronic data to identify people who should no longer take low-dose aspirin is unknown. Thus, the goal of this study was to investigate the suitability of EHRs to identify patients for deprescribing aspirin based on updated guidelines. This study used three guidelines: #1 Low-dose aspirin (75-100mg orally daily) might be considered for the primary prevention of ASCVD among select adults – 40 to 70 years of age – who are at higher ASCVD risk but not at increased risk of bleeding; #2 Low-dose aspirin should not be administered on a routine basis for the primary prevention of ASCVD among adults >70 years of age; #3 Low-dose aspirin should not be administered for the primary prevention of ASCVD among adults of any age who are at increased risk of bleeding. Using VA data, investigators examined the electronic health records of nearly 5.6 million Veterans engaged in VA primary care in 2019 for low-dose aspirin use for the primary prevention of ASCVD.
- Many Veterans unnecessarily take low-dose aspirin to prevent cardiovascular disease. Data show that between 2% to 5% of Veterans in this study took low-dose aspirin outside of the guidelines and qualify for the definition of medication overuse as defined by the Institute of Medicine.
- The percentage of Veterans with low-dose aspirin use was especially high in people aged 50-79 (83%, 220,892/266,812 total patients with low-dose aspirin use without ASCVD). The true numbers are likely even higher given the incomplete capture of aspirin use in the EHR.
- Of the three updated guidelines for low-dose aspirin in the primary prevention of ASCVD, only guideline #2 (relating to people age >70) could be implemented as an electronic search.
- Low-dose aspirin use in the Veteran population age >70 is common and places them at increased risk of major bleeding events. It is difficult to apply updated ACC/AHA low-dose aspirin guidelines in a comprehensive manner using EHR data because use of low-dose aspirin is not always captured nor can all patients at high risk of ASCVD be identified.
- Investigators were unable to obtain exact numbers for two out of three guidelines since they could not completely define “higher ASCVD risk” and “increased risk of bleeding” within the EHR.
Drs. Ong, Chui, Justice, and Hauser are part of the VA Connecticut Healthcare System. Drs. Hauser and Justice also are part of HSR&D’s Pain Research, Informatics, Multi-morbidities, and Education Center in West Haven, CT.
Ong S, Chui P, Bhargava A, Justice A, and Hauser R. Estimating Aspirin Overuse for Primary Prevention of Atherosclerotic Cardiovascular Disease (from a Nationwide Healthcare System). The American Journal of Cardiology. December 15, 2020;137:25-30.