Aspirin Adherence Research Articles

The value of a mobile educative Application additional to Standard counselling on aspirin Adherence in Pregnancy: the ASAP study, a randomised controlled trial

ObjectiveTo assess the added value of a novel, mobile educative application to standard counselling on aspirin adherence during pregnancy versus standard counselling alone. MethodsParticipants were randomly assigned for additional use of a mobile educative application or standard counselling alone. Main outcome measures were adherence to aspirin measured by two validated questionnaires: Simplified Medication Adherence Questionnaire (SMAQ), Believes and Behaviour Questionnaire (BBQ), and patients reported tablet intake >90%. ResultsA total of 174 women with an indication for aspirin during pregnancy were included. The questionnaires were filled in by 126 out of the 174 participants (72.4%). Similar results were found in the app group and the standard counselling groups for both validated questionnaires. Tablet intake >90% was seen in 88.7% and 87.5% (p = 0.834) of the app group and standard counselling group respectively. Subgroup analyses demonstrated a negative effect of BMI and a positive effect of educational level on adherence. ConclusionsOur study revealed no added effect of a novel, mobile educative application to standard counselling on aspirin adherence during pregnancy. Tablet intake was equally high in both groups probably explained by our high educated population. InnovationFuture studies should focus on tailored counselling on medication to pregnant women's needs including medication reminders, addressing concerns, adequate health literacy and side effects, offering rewards to further stimulate aspirin adherence in pregnancy with optimal outcome for mother and their neonate.

Long-term aspirin adherence following myocardial infarction and risk of cardiovascular events.

Aspirin is considered mandatory after myocardial infarction (MI). However, its long-term efficacy has been questioned. This study investigated the effectiveness of long-term aspirin after MI. Patients≥40 years with MI from 2004-2017 who were adherent to aspirin one year after MI were included from Danish nationwide registries. At 2, 4, 6, and 8 years after MI, continued adherence to aspirin was evaluated. Absolute and relative risks of MI, stroke, or death at 2 years from each timepoint were calculated using multivariable logistic regression analysis with average treatment effect modeling standardized for age, sex, and comorbidities. Subgroup analyses were stratified by sex and age>and≤65 years. Among 40114 individuals included, the risk of the composite endpoint was significantly higher for nonadherent patients at all timepoints. The absolute risk was highest at 2-4 years after MI for both adherent (8.34%, 95% confidence interval [CI]: 8.05-8.64%) and nonadherent patients (10.72%, 95% CI: 9.78-11.66%). The relative risk associated with nonadherence decreased from 4 years after index-MI and onwards: 1.41 (95% CI: 1.27-1.55) at 4-6 years and 1.21 (95% CI: 1.06-1.36) at 8-10 years (Ptrend=0.056). Aspirin nonadherence in women and individuals>65 years was not associated with increased risk. Pinteraction at each of the timepoints: Age-<0.001, <0.001, 0.002, 0.51; Sex-0.25, 0.02, 0.02, 0.82. Nonadherence to long-term aspirin was associated with increased risk of MI, stroke, or death, but not in women or individuals>65 years. The risk decreased from 4 years after MI with near statistical significance.

Long-term aspirin adherence and risk of cardiovascular events and death after myocardial infarction: A nationwide cohort study

Abstract Background Aspirin is mandatory in the acute phase after myocardial infarction (MI); however, the efficacy of aspirin for long-term secondary prevention is less established and may have changed with the addition of modern therapies and diagnostics methods. Purpose To investigate the effectiveness of adherence to long term aspirin therapy at different timepoints following MI. Methods Using Danish nationwide registries, we included patients ≥40 years with a first time MI undergoing percutaneous coronary intervention from 2004 through 2017, who were alive, not treated with anticoagulants, and had stayed adherent to aspirin at one year after the index event (Figure 1). We evaluated adherence to aspirin therapy as proportion of days covered (PDC) ≤80% and &amp;gt;80% at four landmarks (2, 4, 6, and 8 years after MI, respectively). At each landmark, patients were excluded from the analysis if they had suffered a recurrent MI or stroke, died, emigrated or were on anticoagulant or P2Y12-inhibitor therapy. The absolute and relative risks of a composite of death, recurrent MI, or ischemic stroke at 2 years from each landmark were calculated through multivariable logistic regression analysis with average treatment effect modelling standardized to the distribution of age, sex, diabetes, hypertension, hypercholesterolemia, chronic kidney disease, cancer, peptic ulcer, former bleeding, and chronic obstructive pulmonary disease (as a proxy for smoking). Non-CVD death was used as a neutral comparator. Results A total of 40,114 individuals were included in the analysis. Suboptimal adherence to aspirin (PDC≤80%) increased from 10% at first landmark 2 years after MI to 19% at fourth landmark 8 years after MI (Figure 1). The standardized absolute risk of death, recurrent MI, or ischemic stroke was highest at the first landmark 2 years after MI for both PDC-groups (PDC&amp;gt;80%: 8.34%, 95% confidence interval [CI]: 8.04-8.63% and PDC≤80%: 10.75%, 95% CI: 9.80-11.69%) (Figure 2). The standardized relative risk of the composite endpoint was significantly higher for patients with PDC≤80% at all landmarks. A trend towards a diminished protective effect of long-term aspirin therapy appeared from 4 years after the index MI and onwards, decreasing from 1.40 (95% CI: 1.26-1.53) at second landmark 4 years after MI to 1.20 (95% CI: 1.04-1.35) at fourth landmark 8 years after MI. Overall, we found no difference in the relative risk of non-CV death between PDC-groups. Conclusion Suboptimal adherence to long-term aspirin therapy following MI was associated with an increased risk of recurrent MI, ischemic stroke, or death, but the relative risk appeared to decrease slightly over time from 4 years after the index MI and onwards.Figure 1Figure 2

Assessment of Racial Disparities in Aspirin Prophylaxis for Preeclampsia Prevention.

Low-dose aspirin is recommended for preeclampsia prevention among women with high-risk conditions, including chronic hypertension. Black women have higher rates of hypertensive disorders of pregnancy, and whether this is related to disparities in aspirin prophylaxis is unknown. We investigated the relationship between race and counseling/prescription and uptake of aspirin among a cohort of women with chronic hypertension. This is a single-institution, retrospective cohort study of women with chronic hypertension who delivered between 2016 and 2018. Medical record review was performed to assess counseling/prescription of aspirin prophylaxis and self-reported uptake. Self-reported uptake was determined by mention in the provider's notes or by inclusion in the medication reconciliation system. Demographic and obstetric outcome data were compared by self-reported race (Black vs. all other races) in univariate analysis. Multivariable logistic regression analysis was performed to evaluate the association between race and aspirin adherence. We included 872 women: 361 (41.4%) Black women and 511 (58.6%) white or other race women. Overall, 567 (65.0%) women were counseled and/or given a prescription for aspirin, and 411 (72.4%) of those women reported uptake. Black women were equally likely to be counseled and/or prescribed aspirin compared with all other races (67.3 vs. 63.4%; p = 0.7). However, Black women were less likely to report uptake of aspirin (63.8 vs. 79.0%; p < 0.001). After adjustment for total prenatal visits and tobacco use, Black race was associated with an adjusted odds ratio of 0.53 (95% confidence interval: 0.36-0.78) for uptake of aspirin. In our cohort, recommendation for aspirin prophylaxis was suboptimal in all groups, reaching only 65% of eligible women. Black women were equally likely as women of other races to receive counseling about aspirin, but rates of uptake were lower. Our findings suggest that counseling and prescription of aspirin alone in high-risk Black women are not sufficient for utilization of this intervention. · Rates of counseling about aspirin prophylaxis for preeclampsia did not vary by race.. · Black women had lower rates of uptake of aspirin compared with women of other races.. · Counseling about aspirin was inadequate in general, reaching only 65% of eligible women..

Platelet response to aspirin in UK and Irish pregnancy cohorts: a genome-wide approach

A multi-center prospective cross-sectional and genome-wide association study (GWAS) recruited pregnant women taking low dose aspirin. Objectives were to (i) develop pregnancy-specific 95% reference intervals for a range of laboratory based platelet function tests (PFTs); (ii) select an optimal and acceptable PFT that reflected aspirin’s COX-1 inhibition in women with confirmed aspirin adherence in pregnancy; and (iii) identify genomic variants that may influence pregnant women’s platelet response to aspirin. The study included two independent cohorts of pregnant women. A range of PFTs and matched phenotyping with urinary 11-dehydrothromboxane B2 (11DTXB2) and nuclear magnetic resonance (NMR) spectroscopy detection of urinary salicyluric acid as a measure of aspirin adherence were performed. Genome-wide data was acquired from the UK Biobank Axiom® (Thermo Fisher Scientific). 11DTXB2 in combination with adherence testing with NMR salicyluric acid was an accurate and acceptable testing strategy for detecting biochemical aspirin responsiveness in pregnant women, with the provision of relevant reference ranges. GWAS meta-analysis found no significant single nucleotide polymorphisms in association with response to aspirin in pregnancy. Further evaluation in relation to effective dosing of aspirin in pregnancy and optimizing the benefits to specific subgroups should now be a priority for future research.

Adherence to dual antiplatelet therapy after coronary stenting: A study conducted at two Vietnamese hospitals.

Introduction: Adherence to dual antiplatelet therapy (DAPT) is critical after drug-eluting stent(DES) placement. We aimed to assess patient’s knowledge, rates of DAPT adherence, trends in DAPT use over time, and patient‐level factors associated with nonadherence in the patient with acute coronary syndrome (ACS). Methods: ACS patients who received one or more DES between May and September 2018from two hospitals in Vietnam and used DAPT after stent placement were eligible for a direct interview to assess patient’s knowledge on disease and DAPT. Telephone interviews were conducted one, three, and six months following discharge. Nonadherence was defined as premature discontinuation of DAPT. Factors related to nonadherent patients were analyzed using the chi-square test. Results: Of the 200 patients identified, 154 (77%) participated. Of the ten questions related to knowledge, the mean score of correct answers was 8.2 ± 2.3, and 71.7% had good knowledge.Adherence to DAPT was high at one month (94.2%) but declined by three months (44.2%) and then by six months (46.8%). Aspirin adherence was 99.3%-100% throughout. Three factors associated with nonadherence of DAPT following DES placement by six months included: rural location, linactive occupation, and inadequate knowledge on disease and DAPT (p <0.05). Conclusion: DAPT adherence is high at one month but is suboptimal at three and six months.Factors associated with the nonadherence of DAPT will be helpful in the planning of patient education strategies.

Informational needs related to aspirin prophylactic therapy amongst pregnant women at risk of preeclampsia - A qualitative study.

Despite being key to reducing the occurrence of pre-eclampsia in high-risk women, adherence to aspirin prophylaxis is low, reflecting multifactorial challenges faced by pregnant women. It is therefore important to understand the barriers and facilitators of aspirin adherence in pregnancy. This sub-analysis of a qualitative study conducted to better understand barriers and facilitators of aspirin adherence was set to describe informational needs related to aspirin use in pregnancy. A qualitative study was conducted with 14 postnatal women from North-East of England, who declared various levels of non-adherence to aspirin (0-5/7 prescribed). A thematic framework analysis of semi-structured interviews was used. Emerging themes associated with informational needs about aspirin use in pregnancy. Main themes identified a) Informational needs, b) Nature of the information seeking behaviour (active vs passive), c) Sources of information, d) Preferred format of information, e) Partners seeking knowledge. Not all women actively seek information; some choose not to pursue it as they find thinking of hypothetical risks disturbing. When information is accessed, women use a wide range of informational resources from scientific articles and National Health Services website to social media sources and word-of-mouth. Women admit that reading leaflets can be difficult, preferring to receive information in interactive ways. Although partners seek information about risks and risk reduction strategies, they are often not included in conversations with health care professionals. New interactive and accessible informational resources are needed to engage pregnant women and their partners in aspirin prophylactic therapy.

Insights from Monitoring Aspirin Adherence: A Medication Adherence Cascade Tool.

BackgroundAdherence to recommended medications is a key issue in the care of patients with cardiovascular disease (CVD) and barriers to adherence are well established during the medication adherence cascade, the processes of prescribing, obtaining, taking, and maintaining medication use. Aspirin avoids many of the barriers in the medication adherence cascade as it does not require a prescription (prescribing) and is inexpensive, easily accessible (obtaining), prescribed once-daily (taking) as an over-the-counter medication and is generally perceived by patients as safe (maintaining). The purpose of this paper is to report aspirin adherence and propose the Medication Adherence Cascade Tool to assist clinicians to consider all aspects of medication adherence.MethodsAdherence to aspirin was monitored with an electronic pillbox. Frequency analysis, independent T-tests, and ANOVA were completed on 151 patients with underlying heart failure who were prescribed aspirin within a larger parent study. Chi-square tests were completed to assess differences in baseline demographic characteristics.FindingsMean aspirin adherence was 82.2% overall, with 11.9% of sample with adherence n le n50%, 18.5% with adherence 50–80%, and 69.5% with adherence ≥80%. Greater adherence was observed in self-identified White as compared to Black patients (84.47% vs 73.53%; p = 0.014), and patients ≥70 years of age compared to <70 years (87.00% vs 77.49%; p = 0.009).InterpretationAspirin adherence was suboptimal despite the fact that it addresses most of the barriers on the medication adherence cascade (ie, relatively easy access, low cost, and low risk). A Medication Adherence Cascade Tool (MACT) is proposed as a clinical guide to facilitate patient–provider co-production of strategies to address medication adherence. The tool can assist patients and providers to co-produce adherence to achieve optimal medication benefits.

Aspirin non-adherence in pregnant women at risk of preeclampsia (ANA): a qualitative study

ABSTRACT Background Antenatal adherence to aspirin prophylaxis is key to reducing the occurrence of a major pregnancy complication: pre-eclampsia (PE). Up to 75% of pregnant women at increased risk of pre-eclampsia do not take aspirin as prescribed. Little research has been done to understand the psychological determinants of aspirin adherence in pregnancy. This qualitative study aimed to explore barriers and facilitators to aspirin adherence in women at increased risk of PE using version 2 of Theoretical Domains Framework (TDF). Methods Fourteen women from the North-East of England who declared various levels of non-adherence to aspirin (0–5 of 7 prescribed tablets/week) were interviewed 4–18 months after delivery, using the TDF as a guide. Semi-structured interviews were digitally recorded and transcribed verbatim. A thematic framework analysis was used. Results Women exhibited both intentional and unintentional non-adherence and faced multiple barriers at a personal and environmental level. They struggled to initiate, implement and persist in taking medication as prescribed. Women expressed inadequate knowledge about PE and aspirin; they struggled to identify as ‘medication takers’ and relate to the risk factors for PE as identified by the midwife. Significant barriers within the health-care environment were identified; women had difficulties obtaining medication and perceived conflict amongst health care professionals regarding medication safety. Conclusion A combination of inadequate knowledge, lack of identification with the risk factors and beliefs about consequences of taking medication were interlinked with other domains, such as environmental context and resonate with the Necessity-Concerns Framework.

The 15-Epilipoxin-A4 Pathway with Prophylactic Aspirin in Preventing Preeclampsia: A Longitudinal Cohort Study.

The benefit of aspirin in preventing preeclampsia is increasingly recognized; however, its mechanism of action remains unclear. Nonobstetric studies have described an anti-inflammatory effect of aspirin through the 15-epilipoxin-A4 pathway (aspirin-triggered lipoxin [ATL]). However, the anti-inflammatory mechanism of aspirin in the prevention of preeclampsia remains unknown. To examine (1) the difference in longitudinal endogenous lipoxin-A4 (En-Lipoxin-A4) concentration in low-risk (LR) and high-risk (HR) pregnancies, and (2) the effect of aspirin on endogenous ATL concentration and the associated effect on cytokine profile of HR women. Plasma from 220 HR women was collected at 12, 16, 20, 24, 28, 32, and 36 weeks of gestation. Adherence to aspirin was biochemically verified. Plasma En-Lipoxin-A4 and ATL concentrations were analyzed using liquid chromatography mass spectrometry, and cytokines, interleukin (IL)-10, tumor necrosis factor-α, interferon-γ, IL-8, and IL-1β, with the high-sensitivity multibead Luminex® assay. HR women have up to 70% lower plasma concentration of En-Lipoxin-A4 (P < 0.001) than LR women. HR women with adequate aspirin adherence (HR-AA) (n = 82) had higher plasma concentration of ATL (P < .001), lower concentration of IL-8 from 16 to 36 weeks of gestation (P < .001), and increased IL-10 concentration from 16 to 28 weeks of gestation (P = .03) compared with high-risk women who were not on aspirin (HR-NA). HR-AA who did not develop preeclampsia had higher plasma En-lipoxin-A4 (P < .001), ATL (P = .02), and IL-10 concentrations (P < .001) with lower IL-8 concentration (P = .004) than HR women who developed preeclampsia. Plasma concentration of En-Lipoxin-A4 is lower in HR women than in LR controls. Adequate adherence with aspirin results in an increase in ATL and IL-10 with reduced IL-8 plasma concentration. This study suggests a potential anti-inflammatory role of aspirin through the ATL pathway with prophylactic aspirin in HR pregnant women.

A behavioral economics-based telehealth intervention to improve aspirin adherence following hospitalization for acute coronary syndrome.

A significant number of patients with acute coronary syndrome (ACS) are nonadherent to aspirin after hospital discharge, with an associated increased risk of subsequent cardiovascular events. The purpose of this pilot study was to test the efficacy of a telehealth intervention based on behavioral economics to improve aspirin adherence following hospitalization for ACS. We enrolled 130 participants (c¯X = 58 ± 10.7 years of age, 38% female, 45% black) from two hospitals. Patients were eligible if they owned a smartphone and were admitted to the hospital for ACS, prescribed aspirin at discharge, and responsible for administering their own medications. Consenting participants were randomized to the intervention or usual care group. The intervention group was eligible to receive up to $50 per month if they took their medicine daily, with $2 per day deducted if a dose was missed. All participants received an electronic monitoring (EM) pill bottle containing a 90-day supply of aspirin, which was used to measure adherence calculated as the proportion of prescribed drug taken using the EM device. Based on the skewness in the adherence distribution, quantile regression was used to evaluate the effect of the intervention on median adherence over time. After 90 days, adherence fell in the control group but remained high in the intervention group (median adherence 81% vs 90%, P = .18). Rehospitalization was higher in the control group (24% vs 13%, P = .17). A loss aversion behavioral economics-based telehealth intervention is a promising approach to improving aspirin adherence following hospitalization for ACS.

741: Assessment of racial disparities in aspirin prophylaxis for preeclampsia prevention

Low-dose aspirin is recommended for preeclampsia prevention in high-risk conditions, including chronic hypertension (cHTN). Black women have higher rates of hypertensive disorders of pregnancy, and whether this is related to disparities in aspirin prophylaxis is unknown. We investigated the relationship between race and counseling, prescription, and adherence to aspirin among a cohort of women with cHTN. This is a retrospective cohort study of women with cHTN who delivered between January 2017 and September 2018. Medical record review was performed to assess counseling, prescription and self-reported adherence to aspirin prophylaxis. Demographic and obstetric outcome data were compared by self-reported race (black vs. all other races) in univariate analysis. Multivariable logistic regression analysis was performed to evaluate the association between race and aspirin adherence. We included 821 women: 296 (36.1%) black women and 525 (63.9%) white or other race women. Black women were more likely to be multiparous, have higher BMI, use tobacco, and have fewer prenatal visits (Table 1). 488 (59.2%) women were counseled and/or given a prescription for aspirin, and 353 (72.3%) of those women reported adherence. Black women were more likely to be counseled and/or prescribed aspirin compared to all other races (64.5% vs 56.6%; p= 0.03), but were less likely to report adherence (65.4% vs 76.8%; p=0.006). Among women who were counseled or prescribed aspirin, after adjustment for total prenatal visits and tobacco use, black race was associated with an aOR 0.61 (95% 0.39-0.94) of adherence with aspirin. In our cohort, black women were more likely than women of other races to receive counseling about aspirin, but rates of uptake were lower. This may be secondary to factors such as health literacy or medical mistrust. Our findings suggest that counseling and prescription of aspirin alone in high-risk black women are not sufficient, and additional research should focus on overcoming contributory social determinants of health.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Impact of educational preeclampsia prevention booklet on knowledge and adherence to low dose aspirin among pregnant women with high risk for preeclampsia.

Background Postpartum bleeding and pregnancy induced hypertension - including preeclampsia - remain to be a great cause of maternal mortality. The use of aspirin for preventing preeclampsia has been practiced recently by fetomaternal specialists in Indonesia. This study aimed to analyze the impact of education using an aspirin booklet provided by pharmacists on knowledge and adherence in taking aspirin among pregnant women with high risk for preeclampsia. Methods This was one group of pretest-posttest study. We enrolled all pregnant women with high risk for preeclampsia screened at 11+0-13+6 weeks' gestation at Fetomaternal Clinic, Dr. Ramelan Naval Hospital, Surabaya. All subjects prescribed with low-dose aspirin (100 mg) for preeclampsia prevention received oral and written education using the aspirin booklet and had been followed up for 2 months. Knowledge about aspirin for preeclampsia prevention was measured by a validated questionnaire developed for this study. Adherence to aspirin was measured by pill count method. Results A total of 12 pregnant women with high risk for preeclampsia were included during the study period. This study showed a statistically significant difference on knowledge of preeclampsia prevention before and after receiving oral and written education using aspirin booklet (p-value = 0.020), as well as aspirin adherence (p-value = 0.011). Conclusion The use of oral education and written aspirin booklet provided by pharmacists had impact on knowledge of preeclampsia prevention and adherence in taking aspirin among pregnant women with high risk for preeclampsia. We recommend to conduct randomized control study of adequate number of subjects.

Hypertension Editors' Picks Preeclampsia.

Hypertension Editors' Picks Preeclampsia.

Abstract 153: Predictors of Aspirin Nonadherence in Adults with Prior Myocardial Infarction

Background: Medication nonadherence is an alarming public health concern due to its effect on both individual treatment success and overall health care costs. In this study, we sought to identify the predictors of aspirin nonadherence in adults with prior myocardial infarction (MI). Methods: The 2017 Centers for Disease Control’s Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of 2,173 adults with prior MI who had reported the presence or absence of regular aspirin use. Demographic and clinical history were recorded and compared in individuals reporting the presence versus absence of aspirin adherence (defined as self-reported regular use of aspirin). Results: Among 2,173 adults with prior MI, 1623 (74.7%) reported adherence to aspirin while 550 (25.3%) reported aspirin nonadherence. Adults with aspirin nonadherence were younger, and more likely to be female (50.2% vs. 40.8%, p&lt;0.001), Black (16.3% vs. 12.1%, p&lt;0.001), and of Hispanic ethnicity (21.0% vs. 10.0%, p&lt;0.001). They were also less likely to have health insurance (92.1% vs. 95.2%, p=0.007) or own a home (62.6% vs. 72.3%, p&lt;0.001), and had lower annual incomes. Adults with aspirin nonadherence were noted to have less frequent medical checkups and lower rates of multiple comorbidities including diabetes mellitus (33.9% vs. 39.9%, p=0.012), hypertension (72.8% vs. 78.0%, p=0.013), hyperlipidemia (61.7% vs. 70.3%, p&lt;0.001), and obesity (39.4% vs. 41.9%, p=0.013). In multivariate analysis, independent predictors of aspirin nonadherence in this population included female sex (adjusted odds ratio (OR) [95% confidence interval]) = 1.45 [1.14-1.83], Black race (1.64 [1.19-2.26]), Hispanic ethnicity (2.27 [1.61-3.21]), current employment (1.74 [1.28-2.36]), and absence of homeowner status (0.71 [0.55-0.93]). Conclusion: In this observational contemporary study of adults with prior MI, predictors of aspirin nonadherence include female sex, Black race, Hispanic ethnicity, employment status, and homeowner status. Appropriately identifying demographics of patients that may have barriers to adherence, especially at the time of initial medication recommendations, may help physicians to identify those at heightened risk for future nonadherence, thus allowing for timely and targeted educational and social work interventions to achieve treatment success through improved health outcomes and lower health care costs.

Preeclampsia Prevention Using Routine Versus Screening Test-Indicated Aspirin in Low-Risk Women.

The objective was to evaluate whether routine aspirin 75 mg is more cost-effective than the Fetal Medicine Foundation screen-and-treat approach for preeclampsia prevention in low-risk nulliparous women. A health economic decision analytical model was devised to estimate the discounted net health and cost outcomes of routine aspirin versus Fetal Medicine Foundation screening test-indicated aspirin for a cohort of 100 000 low-risk nulliparous women. Both strategies were compared with no intervention. A subanalysis also compared disaggregated components of the algorithm. The analysis used data from hospital administration, literature, and a randomized controlled trial. Sensitivity analyses assessed the impact of aspirin adherence, test cost, and accuracy on study results. Presumed rates of preeclampsia were 3.75% with no intervention versus 0.45% with aspirin use. Results found that routine aspirin was the preferred strategy, in terms of greater health gains and larger cost savings. It provided 163 quality-adjusted life-years relative to no intervention, whereas the screen-and-treat policy achieved 108 quality-adjusted life-years. Routine aspirin would result in an estimated cost saving of €14.9 million annually relative to no intervention, whereas screen-and-treat approach would result in a smaller cost saving of €3.1 million. When the analysis was extended to consider alternative screen-and-treat strategies, routine aspirin remained the optimally cost-effective approach. In conclusion, routine aspirin use in low-risk nulliparous women has a greater health gain and cost saving compared with both the Fetal Medicine Foundation and other screen-and-treat approaches.

Trial of feasibility and acceptability of routine low-dose aspirin versus Early Screening Test indicated aspirin for pre-eclampsia prevention (TEST study): a multicentre randomised controlled trial

ObjectiveEvaluate the feasibility and acceptability of routine aspirin in low-risk women, compared with screening-test indicated aspirin for the prevention of pre-eclampsia and fetal growth restriction.DesignMulticentre open-label feasibility randomised controlled trial.SettingTwo...

Aspirin adherence after CV event saves costs in patients with T2DM

Aspirin adherence after CV event saves costs in patients with T2DM

Cost-Effectiveness of Aspirin Adherence for Secondary Prevention of Cardiovascular Events.

BackgroundSuboptimal adherence to aspirin therapy for secondary prevention of cardiovascular (CV) events is an important public health problem. Prior studies have demonstrated non-adherent patients are at higher risk of experiencing CV events.ObjectivesThis study aimed to estimate the clinical and economic outcomes of aspirin non-adherence in patients with a prior primary CV event.MethodsWe developed a Markov model to estimate the cost-effectiveness of aspirin adherence from a generic US managed care payer perspective over a 5-year time horizon. Costs, utilities and rates of aspirin adherence, CV events and adverse events were gathered from published literature to populate the model. Outcomes were quality-adjusted life years (QALYs), costs (US$) and incremental cost-effectiveness ratios (ICERs). We applied the model separately to a population without type II diabetes as a comorbidity (non-diabetic model) and a population with type II diabetes (type II diabetes model). A one-way sensitivity analysis was performed to assess the model uncertainty.ResultsThe base case showed adherent patients lived 0.25 and 0.36 QALYs longer than non-adherent patients in the non-diabetic model and type II diabetes model, respectively. Adherence to aspirin had an ICER of US$25/QALY in the non-diabetic population, while it saved US$297 per patient over a 5-year period in the type II diabetes population. One-way sensitivity analysis showed the models were most sensitive to rates of non-fatal events in non-adherent patients.ConclusionThis study suggests aspirin adherence may improve QALYs for patients with a prior primary CV event. Further, it may decrease costs in patients with type II diabetes. While additional research is needed to validate these results, payers may wish to increase strategies to promote adherence in order to improve population health.Trial RegistrationNot applicable.

Using extended theory of planned behavior to understand aspirin adherence in pregnant women.

To use the Theory of Planned Behavior (TPB) combined with action and coping planning plus global relationship with husband to explain the aspirin adherence in a sample of women with high-risk pregnancy. A total of 535 Iranian women (mean age = 32.29 ± 4.98; year of marriage = 6.89 ± 3.61) completed the study. Each participant filled out several questionnaires on TPB (i.e., a widely applied theory describing how behaviors are influenced by beliefs, attitudes, perceived behavioral control and behavioral intentions), action planning, coping planning and relationship with husband at baseline. Eight weeks later, each participant completed the Five-item Medication Adherence Rating Scale (MARS-5) and underwent the blood test on aspirin serum level to provide the subjective and objective aspirin adherence information, respectively. Structural equation modeling (SEM) was applied to test three proposed models on aspirin adherence. The TPB with planning plus relationship with husband was supported (comparative fit index = 0.969; Tucker-Lewis index = 0.950). Behavioral intention was the mediator in the associations of aspirin adherence and the following variables: attitude, perceived behavioral control, and relationship with husband. Action and coping planning mediated the associations of aspirin adherence and the two variables of behavioral intention and perceived behavioral control. Relationship with husband mediated the association of subjective norm and aspirin adherence. The TPB model with (action and coping) planning plus relationship with husband serves a potential mechanism to explain the aspirin adherence for women with high risk of pregnancy. Possible implications are discussed based on our results.