Guideline concordance of aspirin use for primary prevention in adult outpatients

Recent guidelines have recommended a reduced role for primary prevention aspirin use, which is associated with an increased bleeding risk. This study aimed to characterize guideline-discordant aspirin use among adults in a community care setting. As part of a quality improvement initiative, patients at 1 internal medicine and 1 family medicine clinic affiliated with an academic hospital were sent an electronic survey. Patients were included if they were at least 40 years old, had a primary care provider at the specified site, and were seen in the last year. Patients were excluded if they had an indication for aspirin other than primary prevention. Responses were collected from 15 February to 16 March 2022. Analyses were performed to identify predictors of primary prevention aspirin use and predictors of guideline-discordant aspirin use; aspirin users and nonusers were compared using Fisher exact test, independent samples t tests, and multivariable logistic regression. Of the 1460 patients sent a survey, 668 (45.8%) responded. Of the respondents, 132 (24.1%) reported aspirin use that was confirmed to be for primary prevention. Overall, 46.2% to 58.3% of primary prevention aspirin users were potentially taking aspirin, contrary to the guideline recommendations. Predictors of discordant aspirin use included a history of diabetes mellitus and medication initiation by a primary care provider. In conclusion, primary prevention aspirin use may be overutilized and discordant with recent guideline recommendations for approximately half of the patients, suggesting a need for aspirin deimplementation. These efforts may be best focused at the primary care level.