(Circulation. 2000;101:1097.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Aspirin Use Is Low Among United States Outpatients With Coronary Artery Disease
From the Institute for Health Policy and General Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
Correspondence to Randall S. Stafford, MD, PhD, Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114. E-mail rstafford{at}partners.org
Background—The goal of the present study was to assess national trends and patterns of aspirin use among outpatients with coronary artery disease. Although there is strong evidence that the use of aspirin reduces the risk of death and recurrent events in patients with coronary artery disease, current national patterns of aspirin use are unknown.
Methods and Results—We used data from the 1980 to 1996 National
Ambulatory Medical Care Surveys. These surveys provide a nationally
representative sample of physician activities during
patient visits to physician offices. We evaluated the report of aspirin
as a new or continuing medication in 10 942 visits to cardiologists
and primary care physicians by patients with coronary artery
disease. We evaluated trends in the use of aspirin for 1980 to 1996 and
used logistic regression to identify independent predictors of aspirin
use for 1993 to 1996. Aspirin use in outpatient visits by persons with
coronary artery disease without reported contraindications
increased from 5.0% in 1980 to 26.2% in 1996. Large increases
occurred in the early 1990s. Independent predictors of aspirin use in
1993 to 1996 were male patient gender (29% versus 21% for females),
patient age of <80 years (28% versus 17% for age of 
80 years), and
presence of hyperlipidemia (45% versus 24% for
patients without hyperlipidemia; all comparisons
P<0.001). Cardiologists (37%) were more likely to
report aspirin use than were internists (20%), family physicians
(18%), or general practitioners (11%;
P<0.001). These effects persisted after we controlled
for potential confounders with the use of logistic regression.
Conclusions—Although aspirin use in patients with coronary artery disease has increased dramatically, it remains suboptimum. Low rates of aspirin use and variations in use suggest a need to better translate clinical recommendations into practice.
Key Words: aspirin • heart diseases • prevention
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