Abstract
Introduction
Recent trials like ASCEND, ASPREE, and ARRIVE emphasise the limited efficacy of aspirin in primary cardiovascular prevention and its associated increased bleeding risk, particularly in the elderly. Consequently, the Screening Tool of Older Persons’ Prescriptions (STOPP) criteria does not recommend aspirin treatment for primary cardiovascular prevention in any case. This study aimed to determine the prevalence of inappropriate aspirin use among elderly patients admitted within our department and our ability to correctly identify and discontinue its use.
Methods
Patients aged over 65 years admitted under our team between August-October 2023 were identified retrospectively from our electronic medical record. Inclusion criteria were those admitted on aspirin, while exclusion criteria were incomplete records or in-hospital deaths. Discharge summaries were reviewed to determine if aspirin prescribed for primary prevention was stopped or flagged to GP for review. The secondary outcome assessed statin prescriptions for primary cardiovascular prevention. Data concerning age, sex, and cardiovascular history was extracted.
Results
67 patients were admitted under our team. The mean age was 81.4 years (SD 9.3). There were 27 males (40.3%) and 40 females (59.7%). 18 (26.9%) patients were diagnosed with ischaemic heart disease; 11 (16.4%) had a previous myocardial infarction; 19 (28.3%) had a prior transient ischaemic attack or stroke and 8 (11.9%) patients had previously undergone coronary revascularization. 14 (20.9%) patients were taking aspirin, in which 5 (35.7%) were prescribed for primary prevention, yet none were discontinued or flagged to GP for review.10 patients (14.9%) received statins for primary prevention, with a 90% adherence to the STOPP criteria.
Conclusion
Despite limited evidence, our analysis found a large proportion of patients from our team were discharged on aspirin for primary prevention. However, adherence to STOPP criteria for statin prescriptions was high. Consequently, we are developing a proforma to assist physicians in discerning inappropriate aspirin prescriptions.