Aspirin use in elderly women receiving medication therapy management services

Abstract

Cardiovascular disease is the largest single cause of death among women in the US. The American Heart Association guidelines recommend aspirin use in women > or = 65 years of age if blood pressure is controlled and the benefits of cardiovascular risk reduction likely outweigh the risk of bleeding. The objective of this study is to determine the prevalence of aspirin use in elderly women and factors associated with use. This retrospective study evaluated aspirin use in women aged > or = 65 years based on cardiovascular and gastrointestinal bleeding risk using a medication therapy management database within a large mid-Atlantic managed care organization. Logistic regression was used to analyze patient-related variables associated with aspirin use. Variables included clinical coronary heart disease (CHD), number of CHD risk factors, diabetes diagnosis, number of chronic medications and presence of contraindications to aspirin. Aspirin use was reported in 50% of patients: 68.0% in the secondary prevention group and 46.3% in the primary prevention group. The percentage of patients using aspirin or with relative aspirin contraindications increased to 84% for the secondary prevention group and 65.9% for the primary prevention group. Patients with clinical CHD and those with diabetes and without clinical CHD were 5.88 (P=0.008) and 7.54 (P=0.012) times more likely to utilize aspirin, respectively, than patients with only one CHD risk factor of age. Patients with relative contraindications to aspirin were less likely to use aspirin (P<0.001). The high use of aspirin in patients at higher CHD risk supports national recommendations. Clinical practitioners need to carefully assess the value of aspirin in patients at low CHD risk and those 80 years of age and beyond where evidence of benefit should be weighed against risk.