Discontinuation of low-dose acetylsalicylic acid therapy in UK primary care: incidence and predictors in patients with cardiovascular disease

continuation of low-dose acetylsalicylic acid therapy in UK primary care: incidence and predictors in patients with cardiovascular disease Original Research (1384) Total Article Views Authors: Martín-Merino E, Johansson S, Bueno H, García Rodríguez LA Published Date March 2012 Volume 2012:3 Pages 1 - 9 DOI: http://dx.doi.org/10.2147/POR.S29557 Received: 28 December 2011 Accepted: 07 February 2012 Published: 16 March 2012 Elisa Martín-Merino1, Saga Johansson2, Héctor Bueno3, Luis A García Rodríguez1 1Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain; 2AstraZeneca R&D, M lndal, Sweden; 3Department of Cardiology, Hospital General Universitario Gregorio Mara ón, Madrid, Spain Background: Discontinuation of low-dose acetylsalicylic acid (ASA) leads to an increased risk of cardiovascular and cerebrovascular events in patients taking low-dose ASA for secondary cardiovascular prevention. However, little is known about the rate of discontinuation in everyday clinical practice. Objectives: To assess the rate of low-dose ASA discontinuation in primary care, and identify factors that predict discontinuation. Methods: The Health Improvement Network, a large UK primary care database, was used to identify patients aged 50–84 years who received at least two consecutive prescriptions for low-dose ASA for secondary cardiovascular or cerebrovascular prevention in 2000–2007 (n = 35,639). Discontinuation was defined as a period of at least 90 days after completion of the last prescribed course of ASA during which no repeat prescription was issued. Results: During the study, 11,729 patients (32.9%) discontinued ASA therapy (mean follow-up 2.5 years). The discontinuation rate was lower in patients with ASA indicated for myocardial infarction than for other indications. The diagnosis of gastrointestinal disorders during the study (overall odds ratio: 1.74; 95% confidence interval: 1.61–1.88) was associated with increased rates of ASA discontinuation, whereas co-prescription of a proton pump inhibitor from the start of ASA therapy was associated with a decreased rate of discontinuation (odds ratio: 0.80; 95% confidence interval: 0.75–0.86). Co-prescription of several other cardioprotective medications was also associated with a reduced risk of discontinuation, as were increasing age, prior hospitalization and overall number of co-medications. Conclusion: Continuous co-prescription of a PPI with low-dose ASA may improve adherence and outcomes, particularly in patients at both cardiovascular and gastrointestinal risk.