Abstract:

Background. Aspirin has been shown to significantly reduce mortality when taken by patients with vascular disease. Studies in secondary care have shown its use to be suboptimal, but aspirin use among general practitioners (GPs) has not been directly assessed, although some data on aspirin use in the community exists. Little is known about factors that might influence aspirin use by GPs, despite much recent research on the wider issues of following evidence-based 'best' practice.

Aims. To determine the use of aspirin by GPs in preventing vascular events, and to identify factors influencing its use.

Method. Postal questionnaire using clinical vignettes sent to all GPs identified from the North Staffordshire Health Authority database.

Results. Of 230 questionnaires sent, 123 were returned giving an overall response of 54%. For patients with vascular disease, a median of 86% of GPs advised aspirin use, with a range from 80% to 96% according to the site of the vascular disease. Responses were analysed when an additional diagnosis was added to the clinical situation. These diagnoses were designed to represent conditions in which aspirin may be used, but with caution. For patients falling into this category, the benefits of aspirin prophylaxis usually outweigh the risks of aspirin use. The addition of such a diagnosis was associated with a median reduction to 67% of responders who indicated that aspirin would be used (range = 66% to 85%). A contraindication to aspirin reduced its use to 66% of the sample. In patients without vascular disease but with multiple risk factors for future cardiovascular disease, the use of aspirin ranged from 17% to 54%. There was self-reported confusion among responders about what dose and formulation of aspirin to advise and prescribe.

Conclusions. The results obtained from the responders may not represent the opinion of all GPs in the North Staffordshire area owing to the low response rate. There is, however, stated unwillingness to advise aspirin prophylaxis by some GPs, even when it is clearly indicated. The presence of comorbidity reduces its use further, regardless of whether this involves a contraindication to aspirin or not. A substantial proportion of GPs are recommending the use of aspirin in patients with risk factors for, but without actual symptoms of, vascular disease. Further education is required to reduce uncertainty about which formulation and dose of aspirin to use. Recommendations from authorities on the subject should be disseminated and must be practical and clear. Research into the failure to incorporate quality research into everyday practice must continue.

Keywords: ASPIRIN CARDIOVASCULAR DISEASE; GENERAL PRACTITIONERS; SECONDARY PREVENTION

Document Type: Research article