Baby aspirin? Many doctors don't recommend, despite guidelines

Baby aspirin? Many doctors don't recommend, despite guidelines

A majority of middle-aged men and women eligible to take aspirin to prevent heart attack and stroke do not recall their doctors ever telling them to do so, according to a University of Rochester study of a national sample of more than 3,000 patients.

Published online by the Journal of General Internal Medicine, the finding illustrates a common disconnect between public health guidelines and what occurs in clinical practice. The UR study is consistent with other research showing that physicians often do not recommend as prevention therapy to the general population, despite established guidelines by the U.S. Preventative Services Task Force.

Several reasons might explain the reluctance, such as competing demands and limited time to properly assess a patient's eligibility for aspirin, according to lead author Kevin A. Fiscella, M.D., M.P.H., professor of Family Medicine at the UR School of Medicine and Dentistry.

Uncertainty about the benefits of aspirin therapy versus potential harms like bleeding in the digestive track, also hinder physicians' decisions, the study said.

For the JGIM study, Fiscella's group analyzed data from 3,439 patients included in the 2011-'12 National Health and Nutrition Examination Survey (NHANES). None of the patients had cardiovascular disease, but all qualified for based on their 10-year risk score for factors such as diabetes, , obesity, smoking, and use of cholesterol-lowering medications.

Of the sample, 87 percent of men and 16 percent of women were eligible to take aspirin as a preventive measure. But when they were asked the question—"Doctors and other sometimes recommend that you take a low-dose aspirin each day to prevent , strokes, or cancer. Have you ever been told to do this?"—a low rate of 34 percent of the men and 42 percent of the women said yes.

Co-author John Bisognano, M.D., Ph.D., director of outpatient cardiology services at UR Medicine, said most physicians can agree on approaches to medical care in immediately life-threatening situations, but have less enthusiasm to quickly embrace preventive guidelines, particularly when they involve wide-ranging interventions for a large segment of the population.

New studies that present conflicting data or re-interpret older data also complicate the issue and can be confusing for patients, he said. Despite the USPSTF guidelines for aspirin being published in 2009, for example, the FDA declined to approve the same recommendations as recently as last spring.

"Patients often view changes as an illustration that folks in the medical field can't really make up their minds," said Bisognano, professor of Medicine. "Changes can undermine a practitioner's or patient's enthusiasm to immediately endorse new guidelines because they wonder if it will change again in three years."

But science and medical practice is fluid, he said, and the only way to move the field forward is to continually understand and look for ways to apply the new data and avoid assumptions of the past.

The study also noted that using expanded primary care teams of nurses, medical assistants, and health educators may help to reduce the volume of decisions that rest solely with the physician at the office visit. Sharing care can improve agreement between published guidelines, the use of risk models, and actual practice, the study said.

More information: Journal of General Internal Medicine, link.springer.com/article/10.1… 07/s11606-014-2985-8

add to favorites email to friend print save as pdf

Related Stories

Daily aspirin regimen not safe for everyone, FDA warns

May 06, 2014

(HealthDay)—Taking an aspirin a day can help prevent heart attack and stroke in people who have suffered such health crises in the past, but not in people who have never had heart problems, according to ...

Aspirin not always best treatment for many individuals

May 16, 2013

(Medical Xpress)—An aspirin a day may not always keep heart disease away, say two University of Florida cardiologists. But a new algorithm they have developed outlines factors physicians should weigh as ...

Recommended for you

Have a cold? Don't ask your doctor for antibiotics

11 hours ago

Antibiotic resistance is a major threat to public health. Resistance makes it harder for physicians to treat infections and can increase the chance patients will die from an infection. What is more, the treatment ...

Powdered measles vaccine found safe in early clinical trials

Nov 25, 2014

A measles vaccine made of fine dry powder and delivered with a puff of air triggered no adverse side effects in early human testing and it is likely effective, according to a paper to be published November 28 in the journal ...

User comments

Adjust slider to filter visible comments by rank

Display comments: newest first

countusin2
not rated yet Aug 05, 2014
of course they don't. no one is paying them to recommend aspirin. Doctors are all about kickbacks. if the oil companies would pay them they would prescribe gasoline...

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.