Use of Health Care System-Supplied Aspirin by Veterans With Postoperative Heart Attack or Unstable Angina.
Evidence-based guidelines for the use of aspirin in secondary prevention of cardiovascular disease events are well established. Despite this, the prevalence of aspirin use for secondary prevention is suboptimal. The study aimed to determine the prevalence of aspirin use for secondary prevention of cardiovascular disease events when it is dispensed as a prescription, as is performed in the Veterans Affairs (VA) managed care system. VA patients who had undergone major surgery and experienced a postoperative myocardial infarction (MI) or unstable angina between the years 2005 and 2009 were identified from administrative databases. VA pharmacy records were used to determine whether a prescription for aspirin was filled after the postoperative MI or unstable angina. Multivariable logistic regression models estimated odd ratios of filling aspirin prescriptions for the predictors of interest. Of the 321,131 men and women veterans who underwent major surgery, 7,700 experienced a postoperative MI or unstable angina. Among those 7,700, 47% filled an aspirin prescription. Only 59% of veterans with no co-pay filled an aspirin prescription. Aspirin fills were more common in younger veterans, Blacks, Hispanics, males, hypertensive veterans, mentally ill patients, those with no co-pay and those prescribed antiplatelets/anticoagulants in addition to aspirin postoperatively. These findings suggest that the impact of dispensing aspirin as a prescription may not be significant in increasing the appropriate use of aspirin for secondary prevention.
Center for Applied Health Research, Department of Medicine, Baylor Scott & White Health (CMR, LAC, CJM), jointly with Central Texas Veterans Health Care System, Temple, Texas; Departments of Internal Medicine and Clinical Sciences, University of Texas Southwestern Medical Center (EMM); Research Service, South Texas Veterans Health Care System (MJP); and Department of Epidemiology & Biostatistics, University of Texas Health Science Center San Antonio (DJM).
Cathleen M
CM
Rivera
Laurel A
LA
Copeland
Catherine J
CJ
McNeal
Eric M
EM
Mortensen
Mary J
MJ
Pugh
Daniel J
DJ
MacCarthy
D000368:Aged; D000789:Angina, Unstable / Q000150:complications* / Q000517:prevention & control*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use*; D002309:Cardiology / Q000379:methods / Q000592:standards; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000517:prevention & control*; D011183:Postoperative Complications; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin