plenary iii ask about aspirin
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Plenary III Ask About Aspirin . Stanton Shanedling, PhD, MPH Supervisor , Heart Disease & Stroke Prevention Unit, Minnesota Department of Health . Colleagues. Alan T. Hirsch, MD - PowerPoint PPT PresentationTRANSCRIPT
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Plenary III
Ask About Aspirin
Stanton Shanedling, PhD, MPHSupervisor, Heart Disease & Stroke Prevention Unit, Minnesota Department of Health
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Colleagues
• Alan T. Hirsch, MD Professor of Medicine, Epidemiology & Community Health Director, Vascular Medicine Program, Lillehei Heart Institute, University of Minnesota - Medical School
• John R. Finnegan, PhD Professor & Dean, Vice President of Public Health, University
of Minnesota - School of Public Health
• Russell V. Luepker, MD, MS Mayo Professor of Public Health, Division of Epidemiology &Community Health, University of Minnesota - School of Public Health
Niki Oldenburg, DrPhResearch Team Leader, Vascular Medicine Program
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Goal: Statewide initiative to reduce CVD by promoting a community intervention to increase the appropriate use of low dose aspirin in
target populations
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Utilize United States Preventive Services Task Force (USPSTF) aspirin recommendations for the primary prevention of cardiovascular disease:
▪▪Encourage men age 45 to 79 years to use aspirin when the potential benefit of a reduction in myocardial infarctions outweighs the potential harm of an increase in gastrointestinal hemorrhage. (USPSTF “A” recommendation)
▪▪Encourage women age 55 to 79 years to use aspirin when the potential benefit of reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. (USPSTF “A” recommendation)
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Background
Baseline data prior to intervention- 2009 • 35% of men age 45-79 and 37% of women age 55-79 reported taking ASA
(MN Heart Survey)• 19% of all deaths in Minnesota due to Heart Disease (18% in 2011)• 6% of all deaths in Minnesota due to Stroke (5% in 2011)
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Interventions to increase use of low-dose ASA
1. Health Professional Education – reaching physicians, pharmacists, nurses and other health professionals to disseminate new practice tools to improve aspirin use in the target patient population
2. Shared Media – engaging the public through the use of on-line resources to engage adherence to aspirin use;
3. Mass Media – reaching the public via use of traditional mass media, including television, newspapers, radio station, billboards, etc.
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Goals
• Increase aspirin intake by an absolute 10% in Minnesota adult population of men age 45-79 and women age 55-79.
• Reduce the number of first heart attacks and strokes in the target population in Minnesota.
• Verify the impact of newly developed prevention tools and measure the effects of the campaign, in order to assure that the most effective tools
can be disseminated across the State of Minnesota, as a national model.
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Clinic Based Interventions: Hibbing, MN Three Health Systems
1. Patient identification and activation
2. Provider and team behavior awareness and activation
3. Community Systems Change – Community Health Coordinator
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Public Awareness
85% liked the ads72% found the ads engaging95% found the ads believable87% trusted the ads87% had a favorable reaction
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Aspirin Use in Hibbing: Self-Report and Assay Results
ASA use
Total Group (n=103)
Primary Prevention (n=74)
Secondary Prevention (n=29)
Self-reported use 52 (50.5) 28 (37.8) 24 (82.8)Self-reported daily use 49 (47.6) 27 (36.5) 22 (75.9)Regularly take aspirin toprevent MI or stroke
50 (48.5) 26 (35.1)
Assay results (n=54) Thromboxane <25ng/ml 36/54 (66.7) 23/38 (60.5) 13/16 (81.3) Self-reported use* 32/54 (59.3) 18/38 (47.4) 14/16 (87.5) Self-reported daily use** 31/54 (57.4) 17/38(44.7) 14/16 (87.5)
37% 79%
Before the campaign the primary prevention group rarely asked their clinician about aspirin use to prevent a heart attack or stroke (less
than 1 in 5 individuals).
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Self-Reported Aspirin Use in the Primary Prevention Cohort
ASA use
Pre-Campaign(n=74)
Post-Campaign (n=85)
Self-reported daily use* 27/74 (37%) 44/85 (52%)Regularly take aspirin toprevent MI or stroke 26/74 (35%) 39/85 (46%)
*Answered “daily” to the question “How often do you take aspirin”?
36%
52%
---------- Over four months aspirin use increased ----------
Increasedaspirin
use
This rate of change is higher than temporal trends
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Goals for Next 12 Months
1. Create improved public awareness campaign messages
2. Improve the efficacy of clinic-based ASA use intervention and metrics
> Expand use of the EHR as a tool for medication mgmt and adherence
> Achieve > 90% health professional engagement of ASA primary
prevention learning module
3. The program is prepared to expand to a State or wider intervention in 2014
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Some key questions
• Focus on prevention vis a vis intervention messaging?• Given ABCS why no concerted campaign to support ASA? • Ambiguity in information exchange? • Are there concerns?
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Contacts
Alan T. Hirsch, [email protected]
Stanton Shanedling, PhD, [email protected]
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Plenary III
Ask About Aspirin Q and A