title: Do clinicians recommend aspirin to patients for primary prevention of cardiovascular disease?
abstract: BACKGROUND
  The United States Preventive Services Task Force (USPSTF) released updated guidelines in 2009 recommending aspirin to prevent myocardial infarction among at-risk men and stroke among at-risk women.
  
  
  OBJECTIVE
  Our aim was to examine clinician aspirin recommendation among eligible persons based on cardiovascular risk scores and USPSTF cutoffs.
  
  
  METHODS
  We used across-sectional analysis of a current nationally representative sample.
  
  
  METHODS
  Participants were aged 40 years and older, and in the National Health and Nutrition Examination Survey (NHANES) (2011-2012).
  
  
  METHODS
  We determined aspirin eligibility for cardiovascular disease (CVD) prevention for each participant based on reported and assessed cardiovascular risk factors. We assessed men's risk using a published coronary heart disease risk calculator based on Framingham equations, and used a similar calculator for stroke to assess risk for women. We applied the USPSTF risk cutoffs for sex and age that account for offsetting risk for gastrointestinal hemorrhage. We assessed clinician recommendation for aspirin based on participant report.
  
  
  RESULTS
  Among men 45-79 years and women 55-79 years, 87 % of men and 16 % of women were potentially eligible for primary CVD aspirin prevention. Clinician recommendation rates for aspirin among those eligible were low, 34 % for men and 42 % for women. Rates were highest among diabetics (63 %), those 65 to 79 years (52 %) or those in poor health (44 %). In contrast, aspirin recommendation rates were 76 % for CVD secondary prevention. After accounting for patient factors, particularly age, eligibility for aspirin prevention was not significantly associated with receiving a clinician's recommendation for aspirin (AOR 0.99 %; CI 0.7-1.4).
  
  
  CONCLUSIONS
  Despite an "A recommendation" from the USPSTF for aspirin for primary prevention of CVD, the majority of men and women potentially eligible for aspirin did not recall a clinical recommendation from their clinician.
authors.affiliation: Department of Family Medicine, University of Rochester School of Medicine and Dentistry, 1381 South Avenue, Rochester, NY, 14620, USA, Kevin_fiscella@urmc.rochester.edu.
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
authors.forename: Paul C
authors.initials: PC
authors.lastname: Winters
authors.forename: Michael
authors.initials: M
authors.lastname: Mendoza
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Noronha
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Swanger
authors.forename: John D
authors.initials: JD
authors.lastname: Bisognano
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fortuna
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000379:methods; D010819:Physician's Role; D017410:Practice Guidelines as Topic / Q000592:standards; D011322:Primary Prevention / Q000379:methods* / Q000592:standards
chemical_list: D001241:Aspirin
references.citation: J Am Coll Cardiol. 2010 Jun 22;55(25):2878-86
references.pmid: 20579547
references.citation: Stroke. 1995 Sep;26(9):1607-15
references.pmid: 7660407
references.citation: MMWR Suppl. 2012 Jun 15;61(2):11-8
references.pmid: 22695458
references.citation: Arch Intern Med. 2012 Feb 13;172(3):209-16
references.pmid: 22231610
references.citation: J Gen Intern Med. 2013 Apr;28(4):554-60
references.pmid: 23143672
references.citation: JAMA. 2001 May 9;285(18):2370-5
references.pmid: 11343485
references.citation: Eur J Heart Fail. 2010 Nov;12(11):1203-13
references.pmid: 20705688
references.citation: JAMA. 2012 Jun 6;307(21):2318-20
references.pmid: 22706838
references.citation: Ann Pharmacother. 2001 Dec;35(12):1599-607
references.pmid: 11793629
references.citation: J Womens Health (Larchmt). 2012 Apr;21(4):379-87
references.pmid: 22303820
references.citation: J Gen Intern Med. 2013 Jun;28(6):838-44
references.pmid: 23307397
references.citation: Circulation. 2005 Feb 1;111(4):499-510
references.pmid: 15687140
references.citation: Am J Prev Med. 2004 Jan;26(1):56-66
references.pmid: 14700714
references.citation: Implement Sci. 2011 Aug 03;6:89
references.pmid: 21824383
references.citation: Circulation. 1998 May 12;97(18):1837-47
references.pmid: 9603539
references.citation: N Engl J Med. 2012 May 24;366(21):1955-7
references.pmid: 22621625
references.citation: Am J Cardiol. 2012 Apr 15;109(8):1223-8
references.pmid: 22245412
references.citation: BMC Health Serv Res. 2003 Jul 11;3(1):13
references.pmid: 12857356
references.citation: Prev Med. 2005 May;40(5):556-63
references.pmid: 15749138
references.citation: Am J Prev Med. 2007 May;32(5):403-407
references.pmid: 17478266
references.citation: Transl Res. 2011 Nov;158(5):307-14
references.pmid: 22005271
references.citation: J Fam Pract. 1994 Feb;38(2):166-71
references.pmid: 8308509
references.citation: Am J Prev Med. 2006 Jan;30(1):74-7
references.pmid: 16414427
references.citation: Ann Intern Med. 2002 Jan 15;136(2):157-60
references.pmid: 11790071
references.citation: Am J Prev Med. 2012 Feb;42(2):164-73
references.pmid: 22261213
references.citation: JAMA. 2010 Mar 3;303(9):841-8
references.pmid: 20197530
references.citation: Arch Intern Med. 2010 Mar 8;170(5):470-7
references.pmid: 20212185
references.citation: BMC Health Serv Res. 2012 Jan 24;12:20
references.pmid: 22273080
references.citation: Stroke. 1994 Jan;25(1):40-3
references.pmid: 8266381
references.citation: Arch Intern Med. 2010 Feb 8;170(3):230-9
references.pmid: 20142567
references.citation: J Am Med Inform Assoc. 2005 Jul-Aug;12(4):431-7
references.pmid: 15802479
references.citation: BMC Health Serv Res. 2008 Mar 20;8:60
references.pmid: 18366711
references.citation: PLoS One. 2013 Dec 05;8(12):e81970
references.pmid: 24339983
references.citation: BMJ. 1995 Apr 15;310(6985):975-8
references.pmid: 7728035
references.citation: J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2889-934
references.pmid: 24239923
references.citation: Arch Intern Med. 2011 Sep 26;171(17):1558-9
references.pmid: 21949164
references.citation: Am J Med. 2009 Jun;122(6):550-8
references.pmid: 19486718
references.citation: Am J Public Health. 2003 Apr;93(4):635-41
references.pmid: 12660210
references.citation: Lancet. 2009 May 30;373(9678):1849-60
references.pmid: 19482214
references.citation: Ann Intern Med. 1996 Feb 15;124(4):414-21
references.pmid: 8554250
references.citation: Ann Intern Med. 2009 Mar 17;150(6):396-404
references.pmid: 19293072