Evaluation of Provider Implementation of the 2019 American College of Cardiology and American Heart Association Aspirin for Primary Prevention Guideline Recommendations for Older People.

Abstract

Design Retrospective chart review study using electronic medical record data from Inova Health System patients. Setting All cardiology, endocrinology, and primary care outpatient clinics operated by Inova Medical Group (IMG) in Northern Virginia. Participants Participants included were 70 years of age or older and taking aspirin 81 mg as of April 1, 2019. They had completed at least one visit with an IMG provider in primary care, cardiology, or endocrinology clinics between April 1, 2019, and February 17, 2020. Main Outcome Measures The primary outcome of this study was percentage of older people seen by a primary care physician, cardiologist, or endocrinologist since guideline publication who were continued on aspirin for primary prevention. Results The percentage of participants continued on aspirin for primary prevention was 92% versus 8.0% who were discontinued (P < 0.0001). Differences in subgroup analyses based on smoking history, diagnosis of diabetes, or history of venous thromboembolism were not statistically significant. Conclusion There was a significantly greater rate of aspirin continuation versus discontinuation among patients 70 years of age and older in the setting of primary cardiovascular prevention. Based on this result, most primary care physicians, endocrinologists, and cardiologists at this institution have chosen to continue aspirin in older people following the 2019 American College of Cardiology/American Heart Association guideline statement publication.