Aspirin therapy: Effective but underused

In a perspective piece published Jan. 17 in the New England Journal of Medicine, officials from the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Innovation bemoaned the low rate of aspirin therapy for appropriate patients while lauding public and private initiatives to promote it.

Anand K. Parekh, MD, of the Office of the Assistant Secretary for Health, Department of Health and Human Services in Washington, D.C., and colleagues described the high incidence of cardiovascular disease in the U.S.—16 million adults have coronary heart disease, another 7 million have survived a stroke, and 8 million have peripheral artery disease. They noted that that there is substantial evidence that aspirin therapy is effective in reducing the risk of recurrent major coronary events and stroke, and that almost all of these people are candidates for aspirin or other antiplatelet therapy. Yet according to a survey by a division of the CDC, in 2007 to 2008, less than half of this population was prescribed aspirin.

The authors propose focused communication strategies to remind all medical team members to promote aspirin to patients without contraindications to antiplatelet therapy, including embedding reminders into EHR systems. They also advocated incentive systems and quality reporting systems that reward clinicians for adhering to established quality measures, including aspirin therapy for appropriate patients.

“Clinicians need to be reminded of evidence-based guidelines through continuing education and professional activities. In addition, systems-based interventions such as clinical decision support and reinforcement by each member of the care team can ensure that all those who can benefit from aspirin therapy receive it,” they wrote.

The authors were encouraged by efforts to reduce cardiovascular disease and promote effective prevention strategies. They specifically cited the Million Hearts program, which focuses on private and public sector efforts to reduce cardiovascular disease and prevent 1 million heart attacks and strokes by 2017. Targeting people at risk and promoting aspirin to those people is one of the strategies of the program. The authors also commended the American Heart Association’s Get With the Guidelines program, the American College of Cardiology’s PINNACLE program and other efforts within the medical community to promote aspirin as an inexpensive, easy and effective secondary prevention measure for patients at risk.