Contemporary patterns of discharge aspirin dosing after acute myocardial infarction in the United States results from the national cardiovascular data registry (NCDR)

Hurst Hall, James A de Lemos, Jonathan R. Enriquez, Darren K McGuire, S. Andrew Peng, Karen P. Alexander, Matthew T. Roe, Nihar Desai, Stephen D. Wiviott, Sandeep R Das

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background-Accumulated data suggest that low-dose aspirin after myocardial infarction (MI) may offer similar efficacy to higher dose aspirin with reduced risk of bleeding. Few data are available on contemporary aspirin dosing patterns after MI in the United States Methods and Results-Aspirin dosing from 221 199 patients with MI (40.2% ST-segment-elevation MI) from 525 US hospitals enrolled in the National Cardiovascular Data Registry's (NCDR's) Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines were described, overall and in clinically relevant subgroups. Highdose aspirin was defined as 325 mg and low dose as 81 mg. Between January 2007 and March 2011, 60.9% of patients with acute MI were discharged on high-dose aspirin, 35.6% on low-dose aspirin, and 3.5% on other doses. High-dose aspirin was prescribed at discharge to 73.0% of patients treated with percutaneous coronary intervention and 44.6% of patients managed medically. Among 9075 patients discharged on aspirin, thienopyridine, and warfarin, 44.0% were prescribed high-dose aspirin. Patients with an in-hospital major bleeding event were also frequently discharged on high-dose aspirin (56.7%). A 25-fold variation in the proportion prescribed high-dose aspirin at discharge was observed across participating centers. Conclusions-Most US patients with MI continue to be discharged on high-dose aspirin. Although aspirin dosing after percutaneous coronary intervention largely reflected prevailing guidelines before 2012, high-dose aspirin was prescribed with similar frequency in medically managed patients and to those in categories expected to be at high risk for bleeding. Wide variability in the proportional use of high-dose aspirin across centers suggests significant influence from local practice habits and uncertainty about appropriate aspirin dosing.

Original languageEnglish (US)
Pages (from-to)701-707
Number of pages7
JournalCirculation: Cardiovascular Quality and Outcomes
Volume7
Issue number5
DOIs
StatePublished - Sep 1 2014

Fingerprint

Aspirin
Registries
Myocardial Infarction
Percutaneous Coronary Intervention
Hemorrhage
Guidelines
Warfarin
Uncertainty
Habits

Keywords

  • Acute coronary syndrome
  • Aspirin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Contemporary patterns of discharge aspirin dosing after acute myocardial infarction in the United States results from the national cardiovascular data registry (NCDR). / Hall, Hurst; de Lemos, James A; Enriquez, Jonathan R.; McGuire, Darren K; Peng, S. Andrew; Alexander, Karen P.; Roe, Matthew T.; Desai, Nihar; Wiviott, Stephen D.; Das, Sandeep R.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 7, No. 5, 01.09.2014, p. 701-707.

Research output: Contribution to journalArticle

@article{5271c906057c42118d4adfc5a306266c,
title = "Contemporary patterns of discharge aspirin dosing after acute myocardial infarction in the United States results from the national cardiovascular data registry (NCDR)",
abstract = "Background-Accumulated data suggest that low-dose aspirin after myocardial infarction (MI) may offer similar efficacy to higher dose aspirin with reduced risk of bleeding. Few data are available on contemporary aspirin dosing patterns after MI in the United States Methods and Results-Aspirin dosing from 221 199 patients with MI (40.2{\%} ST-segment-elevation MI) from 525 US hospitals enrolled in the National Cardiovascular Data Registry's (NCDR's) Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines were described, overall and in clinically relevant subgroups. Highdose aspirin was defined as 325 mg and low dose as 81 mg. Between January 2007 and March 2011, 60.9{\%} of patients with acute MI were discharged on high-dose aspirin, 35.6{\%} on low-dose aspirin, and 3.5{\%} on other doses. High-dose aspirin was prescribed at discharge to 73.0{\%} of patients treated with percutaneous coronary intervention and 44.6{\%} of patients managed medically. Among 9075 patients discharged on aspirin, thienopyridine, and warfarin, 44.0{\%} were prescribed high-dose aspirin. Patients with an in-hospital major bleeding event were also frequently discharged on high-dose aspirin (56.7{\%}). A 25-fold variation in the proportion prescribed high-dose aspirin at discharge was observed across participating centers. Conclusions-Most US patients with MI continue to be discharged on high-dose aspirin. Although aspirin dosing after percutaneous coronary intervention largely reflected prevailing guidelines before 2012, high-dose aspirin was prescribed with similar frequency in medically managed patients and to those in categories expected to be at high risk for bleeding. Wide variability in the proportional use of high-dose aspirin across centers suggests significant influence from local practice habits and uncertainty about appropriate aspirin dosing.",
keywords = "Acute coronary syndrome, Aspirin",
author = "Hurst Hall and {de Lemos}, {James A} and Enriquez, {Jonathan R.} and McGuire, {Darren K} and Peng, {S. Andrew} and Alexander, {Karen P.} and Roe, {Matthew T.} and Nihar Desai and Wiviott, {Stephen D.} and Das, {Sandeep R}",
year = "2014",
month = "9",
day = "1",
doi = "10.1161/CIRCOUTCOMES.113.000822",
language = "English (US)",
volume = "7",
pages = "701--707",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Contemporary patterns of discharge aspirin dosing after acute myocardial infarction in the United States results from the national cardiovascular data registry (NCDR)

AU - Hall, Hurst

AU - de Lemos, James A

AU - Enriquez, Jonathan R.

AU - McGuire, Darren K

AU - Peng, S. Andrew

AU - Alexander, Karen P.

AU - Roe, Matthew T.

AU - Desai, Nihar

AU - Wiviott, Stephen D.

AU - Das, Sandeep R

PY - 2014/9/1

Y1 - 2014/9/1

N2 - Background-Accumulated data suggest that low-dose aspirin after myocardial infarction (MI) may offer similar efficacy to higher dose aspirin with reduced risk of bleeding. Few data are available on contemporary aspirin dosing patterns after MI in the United States Methods and Results-Aspirin dosing from 221 199 patients with MI (40.2% ST-segment-elevation MI) from 525 US hospitals enrolled in the National Cardiovascular Data Registry's (NCDR's) Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines were described, overall and in clinically relevant subgroups. Highdose aspirin was defined as 325 mg and low dose as 81 mg. Between January 2007 and March 2011, 60.9% of patients with acute MI were discharged on high-dose aspirin, 35.6% on low-dose aspirin, and 3.5% on other doses. High-dose aspirin was prescribed at discharge to 73.0% of patients treated with percutaneous coronary intervention and 44.6% of patients managed medically. Among 9075 patients discharged on aspirin, thienopyridine, and warfarin, 44.0% were prescribed high-dose aspirin. Patients with an in-hospital major bleeding event were also frequently discharged on high-dose aspirin (56.7%). A 25-fold variation in the proportion prescribed high-dose aspirin at discharge was observed across participating centers. Conclusions-Most US patients with MI continue to be discharged on high-dose aspirin. Although aspirin dosing after percutaneous coronary intervention largely reflected prevailing guidelines before 2012, high-dose aspirin was prescribed with similar frequency in medically managed patients and to those in categories expected to be at high risk for bleeding. Wide variability in the proportional use of high-dose aspirin across centers suggests significant influence from local practice habits and uncertainty about appropriate aspirin dosing.

AB - Background-Accumulated data suggest that low-dose aspirin after myocardial infarction (MI) may offer similar efficacy to higher dose aspirin with reduced risk of bleeding. Few data are available on contemporary aspirin dosing patterns after MI in the United States Methods and Results-Aspirin dosing from 221 199 patients with MI (40.2% ST-segment-elevation MI) from 525 US hospitals enrolled in the National Cardiovascular Data Registry's (NCDR's) Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines were described, overall and in clinically relevant subgroups. Highdose aspirin was defined as 325 mg and low dose as 81 mg. Between January 2007 and March 2011, 60.9% of patients with acute MI were discharged on high-dose aspirin, 35.6% on low-dose aspirin, and 3.5% on other doses. High-dose aspirin was prescribed at discharge to 73.0% of patients treated with percutaneous coronary intervention and 44.6% of patients managed medically. Among 9075 patients discharged on aspirin, thienopyridine, and warfarin, 44.0% were prescribed high-dose aspirin. Patients with an in-hospital major bleeding event were also frequently discharged on high-dose aspirin (56.7%). A 25-fold variation in the proportion prescribed high-dose aspirin at discharge was observed across participating centers. Conclusions-Most US patients with MI continue to be discharged on high-dose aspirin. Although aspirin dosing after percutaneous coronary intervention largely reflected prevailing guidelines before 2012, high-dose aspirin was prescribed with similar frequency in medically managed patients and to those in categories expected to be at high risk for bleeding. Wide variability in the proportional use of high-dose aspirin across centers suggests significant influence from local practice habits and uncertainty about appropriate aspirin dosing.

KW - Acute coronary syndrome

KW - Aspirin

UR - http://www.scopus.com/inward/record.url?scp=84911214755&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84911214755&partnerID=8YFLogxK

U2 - 10.1161/CIRCOUTCOMES.113.000822

DO - 10.1161/CIRCOUTCOMES.113.000822

M3 - Article

C2 - 25116897

AN - SCOPUS:84911214755

VL - 7

SP - 701

EP - 707

JO - Circulation: Cardiovascular Quality and Outcomes

JF - Circulation: Cardiovascular Quality and Outcomes

SN - 1941-7713

IS - 5

ER -