Aspirin is effective for the primary and secondary prevention of cardiovascular events, but its use has been suboptimal.
Investigators performed a nationally representative Internet-based survey of U.S. consumers aged 40 and older using online databases maintained by Harris Interactive((R)) to measure use of aspirin for cardiovascular disease (CVD) prevention and factors associated with its use. Respondents reported whether they used aspirin therapy regularly for cardiovascular prevention; and provided information about their cardiovascular risk factors, discussions with their healthcare provider about aspirin therapy, and their perceptions about risks and benefits of aspirin. Objective risk of cardiovascular events was estimated using counts of self-reported risk factors. Survey results were weighted to be representative of the general U.S. population. Researchers performed bivariate and multivariate analyses to understand factors associated with aspirin use.
A total of 1299 adults aged 40 or older completed the survey. Mean age was 55.9, 53% were women, 79% self-identified as white, 10% African American, and 9% Latino. Current regular aspirin use for CVD prevention was reported by 41% of respondents. The factor most strongly associated with aspirin use was reporting a previous conversation with a healthcare provider about aspirin (88% aspirin use among respondents reporting such discussion versus 17% who did not report discussion; odds ratio 36.6, 95% confidence interval 25.9-51.7).
Aspirin use is low, even among patients at increased risk. Better provider-patient communication about aspirin prevention is associated with greater use, and should be a target for future interventions.
"In a recently published primary care physician survey, the authors found that providing 10 year coronary risk information improved some hypothetical prescribing of acetylsalicylic acid and also improved lipid management when the CVD risk was moderately high . Others identified acetylsalicylic acid underuse by some patients with increased risk and potentially inappropriate use by some with low risk [31-33]. Such findings align with our results and suggest that specific guideline recommendations should be provided along with clinical decision support and risk assessment. "
[Show abstract][Hide abstract] ABSTRACT: The prescription of statins is an evidence-based treatment to reduce the risk of cardiovascular events in patients with elevated cardiovascular risk or with a cardiovascular disorder (CVD). In spite of this, many of these patients do not receive statins.
We evaluated the impact of a brief educational intervention in cardiovascular prevention in primary care physicians' prescribing behaviour regarding statins beyond their participation in a randomised controlled trial (RCT). For this, prescribing data of all patients >= 35 years who were counselled before and after the study period were analysed (each n > 75000). Outcome measure was prescription of Hydroxymethylglutaryl-CoA Reductase Inhibitors (statins) corresponding to patients' overall risk for CVD. Appropriateness of prescribing was examined according to different risk groups based on the Anatomical Therapeutic Chemical Classification System (ATC codes).
There was no consistent association between group allocation and statin prescription controlling for risk status in each risk group before and after study participation. However, we found a change to more significant drug configurations predicting the prescription of statins in the intervention group, which can be regarded as a small intervention effect.
Our results suggest that an active implementation of a brief evidence-based educational intervention does not lead to prescription modifications in everyday practice. Physician's prescribing behaviour is affected by an established health care system, which is not easy to change.Trial registration: ISRCTN71348772.
BMC Public Health 07/2013; 13(1):623. DOI:10.1186/1471-2458-13-623 · 2.26 Impact Factor
"This medicine was regularly taken by as many as 32% of PolSenior respondents, both for primary and secondary prevention of cardiovascular disease. ASA use among adults aged 40 years and older in the United States is 41% (data from a nationally representative Internet-based survey involving 1299 adults) . Other antiplatelet drugs were used less frequently in Poland, with ticlopidine used slightly more than clopidogrel (1.6% vs 1.14%), which might be attributed to the price of the drug. "
[Show abstract][Hide abstract] ABSTRACT: Background
In Poland, the prevalence of cardiovascular diseases is increasing. This might be associated with the constantly growing proportion of elderly people and inappropriate cardiovascular prevention. This study aimed to evaluate the frequency of use of oral antiplatelet (OAP) and oral anticoagulant (OAC) drugs among older people in Poland and to assess their association with cardiovascular risk factors.
The study was based on data collected during the implementation of a multicentre, publicly funded research project called PolSenior.
The study group consisted of 4,979 people with the average age of 79.35 ± 8.69 years. Among them, 1,787 people (35.9%) used at least one drug in the prevention of cardiovascular diseases. OAPs were used regularly by 1,648 (33.1%) elderly people and OACs were used by 165 elderly people (3.3%). Acetylsalicylic acid was used by 32.2% of elderly people. Use of drugs significantly depended on age (p < 0.01), sex (p < 0.01), place of residence (p < 0.001), level of education (p < 0.0001) and personal income (p < 0.0001). Among all the respondents treated with OAPs, therapy was applied as secondary cardiovascular prevention in 717 respondents (43.5%), and as primary prevention in 705 respondents (42.8%). Among the respondents treated with OACs, 117 (71%) elderly people had a history of atrial fibrillation. Secondary cardiovascular prevention should be considered in a further 482 respondents (15.1% of untreated elderly people), and primary cardiovascular prevention in 1,447 respondents (45.3%).
Our study is the first to determine the frequency of use of OAP and OAC drugs among elderly people in Poland in relation to cardiovascular risk factors. The most commonly used drug for cardiovascular prevention is acetylsalicylic acid, but it appears that it is used too rarely in high-risk patients. Educational programs should be developed among general practitioners concerning current recommendations for pharmacological cardiovascular prevention.
"In the largest of these studies, there was an increased risk of CC (not LC) in patients on NSAIDs . However, aspirin use constituted only 5.1–6.2% in this study population, far less than what is seen in the United States, where 40% of people over the age of 40 use aspirin . In addition, patients with microscopic colitis often have associated arthralgias, so the association with NSAID use may be a confounding factor rather than the underlying aetiology. "
[Show abstract][Hide abstract] ABSTRACT: Microscopic colitis includes the terms lymphocytic colitis and collagenous colitis, and is a common cause of chronic diarrhoea in older adults. The incidence of microscopic colitis has increased over time and has reached levels comparable to other forms of inflammatory bowel disease. In this chapter, an updated review on the epidemiology, diagnosis and treatment of microscopic colitis has been provided. There is limited data available about eosinophilic colitis, which is the least common of the eosinophilic GI disorders. It is important to rule out the secondary causes of colonic eosinophilia in patients with suspected eosinophilic colitis.
Best practice & research. Clinical gastroenterology 10/2012; 26(5):611-22. DOI:10.1016/j.bpg.2012.11.012 · 3.48 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.