National Trends in Aspirin Use and Expenditures in the United States: Analysis of The Medical Expenditure Panel Survey 2000-2021.
Aspirin
Atherosclerosis
Atherosclerotic cardiovascular disease
Coronary artery disease
Medical Expenditure Panel Survey
Myocardial infarction
Journal
Cardiology and therapy
ISSN: 2193-8261
Titre abrégé: Cardiol Ther
Pays: England
ID NLM: 101634495
Informations de publication
Date de publication:
05 Oct 2024
05 Oct 2024
Historique:
received:
29
05
2024
accepted:
11
09
2024
medline:
6
10
2024
pubmed:
6
10
2024
entrez:
5
10
2024
Statut:
aheadofprint
Résumé
Since its invention in 1897, aspirin (ASA) has been the most widely used and cost-effective antiplatelet agent to prevent and treat atherosclerotic cardiovascular disease (ASCVD). We aimed to study the trends and expenditures associated with ASA use in the USA. We conducted a serial cross-sectional analysis using the Medical Expenditure Panel Survey data from January 2000 to December 2021, focusing on adults aged ≥ 40 years. Total and out-of-pocket expenditures associated with ASA were estimated to 2021 US dollars (USD). Trends, demographics, and predictors of ASA use among patients with and without ASCVD were also evaluated. A total of 53 million adults were identified during the study period. The number of ASA users increased from 2.9 million to 6.6 million with increased female (36.7%-49.7%; p trend = 0.02) and African American (13%-18.9%; p trend = 0.03) representation amongst all ASA users during the survey period. The use of low-dose ASA increased, while high-dose ASA declined significantly. Only 50% of all ASA users had known ASCVD. The most prevalent ASA users among patients with ASCVD were those aged ≥ 70 years, while patients without ASCVD, it was the 50-69 age group. The total annual expenditure on ASA averaged approximately 60 million USD, with 27.3 million USD out-of-pocket. Total and low-dose (81 mg) ASA use has increased, while high-dose (325 mg) ASA has declined. ASA use for primary prevention has risen among adults aged 50-69 years, and patients ≥ 70 years continue to use ASA without known ASCVD. Further studies are needed to understand the implications of increased ASA use, especially among those without ASCVD.
Identifiants
pubmed: 39368027
doi: 10.1007/s40119-024-00385-2
pii: 10.1007/s40119-024-00385-2
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
© 2024. The Author(s).
Références
Virani SS, Alonso A, Aparicio HJ, et al. Heart disease and stroke statistics-2021 update: a report from the American Heart Association. Circulation. 2021;143(8):e254–743. https://doi.org/10.1161/CIR.0000000000000950 .
doi: 10.1161/CIR.0000000000000950
Johnson NB, Hayes LD, Brown K, et al. CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors—United States, 2005–2013. MMWR Suppl. 2014;63(4):3–27.
Chobufo MD, Singla A, Rahman EU, Michos ED, Whelton PK, Balla S. Temporal trends in atherosclerotic cardiovascular disease risk among US adults. Analysis of the National Health and Nutrition Examination Survey, 1999–2018. Eur J Prev Cardiol. 2022;29(18):2289–300. https://doi.org/10.1093/eurjpc/zwac161 .
doi: 10.1093/eurjpc/zwac161
Chobufo MD, Regner SR, Zeb I, Lacoste JL, Virani SS, Balla S. Burden and predictors of statin use in primary and secondary prevention of atherosclerotic vascular disease in the US: from the National Health and Nutrition Examination Survey 2017–2020. Eur J Prev Cardiol. 2022;29(14):1830–8. https://doi.org/10.1093/eurjpc/zwac103 .
doi: 10.1093/eurjpc/zwac103
Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407–77. https://doi.org/10.1093/eurheartj/ehz425 .
doi: 10.1093/eurheartj/ehz425
Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S49-73. https://doi.org/10.1161/01.cir.0000437741.48606.98 .
doi: 10.1161/01.cir.0000437741.48606.98
Force USPST, Davidson KW, Barry MJ, et al. Aspirin use to prevent cardiovascular disease: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(16):1577–84. https://doi.org/10.1001/jama.2022.4983 .
doi: 10.1001/jama.2022.4983
ASCEND Study Collaborative Group, Bowman L, Mafham M, et al. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018;379(16):1529–39. https://doi.org/10.1056/NEJMoa1804988 .
doi: 10.1056/NEJMoa1804988
McNeil JJ, Wolfe R, Woods RL, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379(16):1509–18. https://doi.org/10.1056/NEJMoa1805819 .
doi: 10.1056/NEJMoa1805819
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596–646. https://doi.org/10.1161/CIR.0000000000000678 .
doi: 10.1161/CIR.0000000000000678
Gaziano JM, Brotons C, Coppolecchia R, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet. 2018;392(10152):1036–46. https://doi.org/10.1016/S0140-6736(18)31924-X .
doi: 10.1016/S0140-6736(18)31924-X
Hall HM, de Lemos JA, Enriquez JR, et al. Contemporary patterns of discharge aspirin dosing after acute myocardial infarction in the United States: results from the National Cardiovascular Data Registry (NCDR). Circ Cardiovasc Qual Outcomes. 2014;7(5):701–7. https://doi.org/10.1161/CIRCOUTCOMES.113.000822 .
doi: 10.1161/CIRCOUTCOMES.113.000822
Medical Expenditure Panel Survey. An official website of the Department of Health & Human Services. https://meps.ahrq.gov/mepsweb/ . Accessed 25 Feb 2024.
Force USPST. Aspirin for the primary prevention of cardiovascular events: recommendation and rationale. Ann Intern Med. 2002;136(2):157–60. https://doi.org/10.7326/0003-4819-136-2-200201150-00015 .
doi: 10.7326/0003-4819-136-2-200201150-00015
US Preventive Services Task Force. Aspirin for the prevention of cardiovascular disease: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;150(6):396–404. https://doi.org/10.7326/0003-4819-150-6-200903170-00008 .
doi: 10.7326/0003-4819-150-6-200903170-00008
Bibbins-Domingo K, US Preventive Services Task Force. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: US Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2016;164(12):836–45. https://doi.org/10.7326/M16-0577 .
doi: 10.7326/M16-0577
Graham I, Atar D, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil. 2007;14(Suppl 2):E1–40. https://doi.org/10.1097/01.hjr.0000277984.31558.c4 .
doi: 10.1097/01.hjr.0000277984.31558.c4
Perk J, De Backer G, Gohlke H, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012;33(13):1635–701. https://doi.org/10.1093/eurheartj/ehs092 .
doi: 10.1093/eurheartj/ehs092
Smith SC Jr, Blair SN, Bonow RO, et al. AHA/ACC Guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update. A statement for healthcare professionals from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol. 2001;38(5):1581–3. https://doi.org/10.1016/s0735-1097(01)01682-5 .
doi: 10.1016/s0735-1097(01)01682-5
Fleg JL, Forman DE, Berra K, et al. Secondary prevention of atherosclerotic cardiovascular disease in older adults: a scientific statement from the American Heart Association. Circulation. 2013;128(22):2422–46. https://doi.org/10.1161/01.cir.0000436752.99896.22 .
doi: 10.1161/01.cir.0000436752.99896.22
Centers for Medicare & Medicaid Services, Hospital Readmissions Reduction Program (HRRP). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program . Accessed 25 July 2023.
Desai NR, Udell JA, Wang Y, et al. Trends in performance and opportunities for improvement on a composite measure of acute myocardial infarction care. Circ Cardiovasc Qual Outcomes. 2019;12(3): e004983. https://doi.org/10.1161/CIRCOUTCOMES.118.004983 .
doi: 10.1161/CIRCOUTCOMES.118.004983
Jones WS, Mulder H, Wruck LM, et al. Comparative effectiveness of aspirin dosing in cardiovascular disease. N Engl J Med. 2021;384(21):1981–90. https://doi.org/10.1056/NEJMoa2102137 .
doi: 10.1056/NEJMoa2102137
Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324(7329):71–86. https://doi.org/10.1136/bmj.324.7329.71 .
doi: 10.1136/bmj.324.7329.71
Ansa BE, Hoffman Z, Lewis N, et al. Aspirin use among adults with cardiovascular disease in the United States: implications for an intervention approach. J Clin Med. 2019. https://doi.org/10.3390/jcm8020264 .
doi: 10.3390/jcm8020264
Opotowsky AR, McWilliams JM, Cannon CP. Gender differences in aspirin use among adults with coronary heart disease in the United States. J Gen Intern Med. 2007;22(1):55–61. https://doi.org/10.1007/s11606-007-0116-5 .
doi: 10.1007/s11606-007-0116-5
Boakye E, Uddin SMI, Obisesan OH, et al. Aspirin for cardiovascular disease prevention among adults in the United States: trends, prevalence, and participant characteristics associated with use. Am J Prev Cardiol. 2021;8:100256. https://doi.org/10.1016/j.ajpc.2021.100256 .
doi: 10.1016/j.ajpc.2021.100256
Zhao M, Woodward M, Vaartjes I, et al. Sex differences in cardiovascular medication prescription in primary care: a systematic review and meta-analysis. J Am Heart Assoc. 2020;9(11):e014742. https://doi.org/10.1161/JAHA.119.014742 .
doi: 10.1161/JAHA.119.014742
Luepker RV, Oldenburg NC, Misialek JR, et al. Aspirin use and misuse for the primary prevention of cardiovascular diseases. Am J Prev Med. 2021;60(4):513–9. https://doi.org/10.1016/j.amepre.2020.10.025 .
doi: 10.1016/j.amepre.2020.10.025
Bazargan M, Wisseh C, Adinkrah E, Boyce S, King EO, Assari S. Low-dose aspirin use among African American older adults. J Am Board Fam Med. 2021;34(1):132–43. https://doi.org/10.3122/jabfm.2021.01.200322 .
doi: 10.3122/jabfm.2021.01.200322
Ashraf M, Jan MF, Bajwa TK, Carnahan R, Zlochiver V, Allaqaband SQ. Sex disparities in diagnostic evaluation and revascularization in patients with acute myocardial infarction—a 15-year nationwide study. J Am Heart Assoc. 2023;12(6):e027716. https://doi.org/10.1161/JAHA.122.027716 .
doi: 10.1161/JAHA.122.027716
Drai E, Marques-Vidal P, Bochud M, Vaucher J. Temporal trends in low-dose aspirin use (from the CoLaus|PsyCoLaus Study). Am J Cardiol. 2023;190:61–6. https://doi.org/10.1016/j.amjcard.2022.11.037 .
doi: 10.1016/j.amjcard.2022.11.037
Kristensen AMD, Pareek M, Kragholm KH, Torp-Pedersen C, McEvoy JW, Prescott EB. Temporal trends in low-dose aspirin therapy for primary prevention of cardiovascular disease in European adults with and without diabetes. Eur J Prev Cardiol. 2023. https://doi.org/10.1093/eurjpc/zwad092 .
doi: 10.1093/eurjpc/zwad092
Josefson D. Bayer made to tone down aspirin advertisements. West J Med. 2000;172(3):154. https://doi.org/10.1136/ewjm.172.3.154 .
doi: 10.1136/ewjm.172.3.154
Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315–81. https://doi.org/10.1093/eurheartj/ehw106 .
doi: 10.1093/eurheartj/ehw106
Hira RS, Gosch KL, Kazi DS, et al. Potential impact of the 2019 ACC/AHA guidelines on the primary prevention of cardiovascular disease recommendations on the inappropriate routine use of aspirin and aspirin use without a recommended indication for primary prevention of cardiovascular disease in cardiology practices: insights from the NCDR PINNACLE Registry. Circ Cardiovasc Qual Outcomes. 2022;15(3): e007979. https://doi.org/10.1161/CIRCOUTCOMES.121.007979 .
doi: 10.1161/CIRCOUTCOMES.121.007979
Rhee TG, Kumar M, Ross JS, Coll PP. Age-related trajectories of cardiovascular risk and use of aspirin and statin among US adults aged 50 or older, 2011–2018. J Am Geriatr Soc. 2021;69(5):1272–82. https://doi.org/10.1111/jgs.17038 .
doi: 10.1111/jgs.17038
Hill SC, Zuvekas SH, Zodet MW. Implications of the accuracy of MEPS prescription drug data for health services research. Inquiry Fall. 2011;48(3):242–59. https://doi.org/10.5034/inquiryjrnl_48.03.04 .
doi: 10.5034/inquiryjrnl_48.03.04
Machlin S, Cohen J, Elixhauser A, Beauregard K, Steiner C. Sensitivity of household reported medical conditions in the medical expenditure panel survey. Med Care. 2009;47(6):618–25. https://doi.org/10.1097/MLR.0b013e318195fa79 .
doi: 10.1097/MLR.0b013e318195fa79
Matharu GS, Kunutsor SK, Judge A, Blom AW, Whitehouse MR. Clinical effectiveness and safety of aspirin for venous thromboembolism prophylaxis after total hip and knee replacement: a systematic review and meta-analysis of randomized clinical trials. JAMA Intern Med. 2020;180(3):376–84. https://doi.org/10.1001/jamainternmed.2019.6108 .
doi: 10.1001/jamainternmed.2019.6108
Anderson DR, Dunbar M, Murnaghan J, et al. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. N Engl J Med. 2018;378(8):699–707. https://doi.org/10.1056/NEJMoa1712746 .
doi: 10.1056/NEJMoa1712746