Guideline Concordance of Aspirin Use for Primary Prevention in Adult Outpatients

• Recent guidelines have recommended a more limited role for primary prevention aspirin, which can increase bleeding risk

• Many patients remain on primary prevention aspirin contrary to guideline recommendations, suggesting a need for deprescribing

Recent guidelines have recommended a reduced role for primary prevention aspirin use, which is associated with increased bleeding risk. This study seeks to characterize guideline-discordant aspirin use among adults in a community care setting. As part of a quality improvement initiative, patients at one internal medicine and one 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 sites, 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 February 15 to March 16, 2022. Analyses were performed to identify predictors of primary prevention aspirin use and predictors of guideline-discordant aspirin; aspirin users and non-users were compared using Fisher's exact test, independent samples t-tests, and multivariable logistic regression. Of 1460 patients sent a survey, 668 (45.8%) responded. Of respondents, 132 (24.1%) reported aspirin use that was confirmed to be for primary prevention. Overall, 46.2-58.3% of primary prevention aspirin users were potentially taking aspirin contrary to 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 about half of patients, suggesting a need for aspirin de-implementation. These efforts may be best focused at the primary care level.