Abstract 13410: Measuring Effective Use of Aspirin in the Community: Analysis from the Monitoring Disparities in Chronic Conditions Surveillance System

Abstract

Objectives: Little is known about aspirin use despite its importance in reducing the burden of cardiovascular disease. This is because aspirin is available over-the-counter, rarely billed to insurers, and taken for a variety of reasons. In order to better understand the delivery of aspirin in the community, we examined its use within the Monitoring Disparities in Chronic Conditions study, a population and health facility-based surveillance system designed to track disparities in cardiovascular and pulmonary disease and the delivery of interventions.

Methods: We surveyed non-institutionalized White, African American, and Hispanic adults aged 18 or older living in King County, WA using a multi-mode system for data collection (telephone, web, mail, and in person). We used address-based sampling to select eligible respondents from the community and medical records to select a random sample of patients with study conditions. A subsample was invited to a structured examination for anthropometry, ECG and phlebotomy. We calculated 10 year cardiovascular risk using a Framingham equation. We analyzed blood for the aspirin metabolite salicylic acid using liquid chromatography-mass spectrometry.

Results: As of May 2012, 3,699 surveys were completed (43.7% address-based sample, 56.2% medical record-based). The median age of respondents was 61, with 46.8% male, 6.2% African-American, and 8.8% Hispanic. 65.2% of men and 50.1% of women reported that a health provider had discussed with them the risks and benefits of aspirin to prevent heart attacks and strokes. Aspirin use at least every other day was reported by 56.3% of men and 43.6% of women. Among 238 respondents with a physical exam, cardiovascular risk was elevated higher than 10% in 33.3% of men but only 4.0% of women. Regular aspirin use was reported by 64.3% with cardiovascular risk higher than 10% and 41.6% with lower risk. Salicylic acid above background level (defined as >32 ng/mL) was detected in 86%, 20% and 13% reporting daily, infrequent, or no use, respectively.

Conclusion: Our study, based on self-reported use and blood metabolite level, shows low use of aspirin among persons with elevated cardiovascular risk. Further effort is needed to identify and counsel those who may benefit from aspirin.