Inappropriate Use of Aspirin in Real-Life Cardiology Practice:Results from the Appropriateness of Aspirin Use in Medical Outpatients:A Multicenter, Observational Study (ASSOS) Study

Özcan ÖRSÇELİK, Abdullah Orhan DEMİRTAŞ, Tuncay KIRIŞ, Bülent ÖZLEK, Murat BİTEKER, Ramazan ASAFOĞLU, Emine ALTUNTAŞ, Lütfü BEKAR, Veysel Ozan TANIK, Oğuzhan ÇELİK, Cem ÇİL, Özcan BAŞARAN, Eda ÖZLEK, Aysel GÖKÇEK, Volkan DOĞAN, Erkan DEMİRCİ, Kadriye MEMİÇ SANCAR, Mücahit YETİM, Osman KARAARSLAN, To

Abstract

Background: Indications and appropriateness of aspirin use have notbeen well investigated in Turkey. Aims: To investigate the prescription patterns and appropriateness ofaspirin in a real-world clinical setting. Study Design: Cross-sectional study. Methods: The Appropriateness of Aspirin Use in Medical Outpatients: AMulticenter, Observational Study (ASSOS) is a cross-sectional and mul ticenter study that included 5007 consecutive patients aged 18 or overwho presented to 30 different cardiology outpatient clinics from 14 cit ies throughout Turkey. Only patients using aspirin (80-325 mg) wereincluded. The study population was divided into 2 groups regarding theuse of aspirin: primary prevention (PP) group and secondary prevention(SP) group. The indication of aspirin use was evaluated following the2016 European Society of Cardiology (ESC) and the 2016 United StatesPreventative Services Task Force (USPTF) guidelines in the PP group. Results: A total of 5007 patients (mean age 62.15 ± 11.05, 39%female) were enrolled. The PP group included 1132 (22.6%)patients, and the SP group included 3875 (77.4%) patients. Of the1132 patients, inappropriate use of aspirin was determined in 100% ofthe patients according to the ESC guidelines, and 71% of the patientsaccording to the USPTF guidelines. Multivariate logistic regressionanalysis showed age OR: 0.98 CI (0.97-0.99) P = .037, smoking OR:0.60 CI (0.44-0.82) P = .001, heart failure OR: 2.11 CI (1.14-3.92)P = .017, hypertension OR: 0.51 CI (0.36-0.74) P < .001, diabetesmellitus OR: 0.34 CI (0.25-0.47) P < .001, oral anticoagulant use OR:3.01 CI (1.10-8.25) P = .032, and female sex OR: 2.73 CI (1.96-3.80)P < .001 were independent predictors of inappropriate aspirin use inPP patients. Conclusion: Although there are considerable differences between theUSPTF and the ESC guidelines with respect to recommendations foraspirin use in PP, inappropriate use of aspirin in Turkey is frequentin real-world practice for both guidelines. Besides, heart failure, oralanticoagulant use, and the female sex of the patients were independentpredictors of inappropriate use of aspirin.