Estimating Aspirin Overuse for Primary Prevention of Atherosclerotic Cardiovascular Disease (from a Nationwide Healthcare System)

• Published in: The American journal of cardiology 2020-12, Vol.137, p.25-30
• Main Authors: Ong, Shawn Y., Chui, Philip, Bhargava, Ankur, Justice, Amy, Hauser, Ronald G.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; Angina pectoris; Anticoagulants; Arteriosclerosis; Aspirin; Aspirin - therapeutic use; Atherosclerosis; Atherosclerosis - drug therapy; Bleeding; Cardiology; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - prevention & control; Data search; Delivery of Health Care - statistics & numerical data; Disease prevention; Drug Overdose - epidemiology; Electronic data interchange; Electronic Health Records; Electronic medical records; Female; Guidelines; Health care policy; Heart attacks; Humans; Male; Middle Aged; Patients; Platelet Aggregation Inhibitors - therapeutic use; Population; Primary care; Primary Prevention - methods; Risk Factors; Terminology; United States - epidemiology; Veterans; Young Adult
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2020.09.042

The American College of Cardiology and American Heart Association recently published guidelines narrowing the indications for low-dose aspirin use. The suitability of the electronic health record (EHR) to identify patients for low-dose aspirin deprescribing is unknown. To apply the 3 low-dose aspirin guidelines to EHR data, the guidelines were deconstructed into components from their narrative text and assigned computer-interpretable definitions based on electronic data interchange standards. These definitions were used to search EHR data to identify patients for aspirin deprescribing. To verify EHR records for low-dose aspirin, we then compared the records with a survey of patients’ self-reported use of low-dose aspirin. Of the 3 aspirin guidelines, only 1 had a definition suitable for EHR implementation. The other 2 contained difficult-to-implement phrases (e.g., “higher ASCVD risk”, “increased bleeding risk”). An EHR search with the single implementable guideline identified 86,555 people for possible aspirin deprescribing (2% of 5,598,604). Only 676 of 1,135 (60%) patients who self-reported taking low-dose aspirin had an active EHR record for low-dose aspirin at that time. Limitations exist when using EHR data to identify patients for possible low-dose aspirin deprescribing such as incomplete EHR capture of and the interpretation of non-specific terminology when translating guidelines into an electronic equivalent. In conclusion, data show many people unnecessarily take low-dose aspirin. •Electronic health records do not capture many people on low-dose aspirin.•Guidelines for low-dose aspirin are difficult to apply to electronic data at a population level.•Electronic data show that many people qualify for aspirin overuse.•Opportunities exist for aspirin deprescription.