Related Experiment Video
Updated: Jul 4, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Aspirin for primary prevention of coronary heart disease: using the Framingham Risk Score to improve utilization in a
Steven C Romero1, Kristina M Dela Rosa, Peter E Linz
1Department of Internal Medicine and Cardiology, Naval Medical Center, San Diego, CA, USA. steven.romero@med.navy.mil
Insights
Aspirin helps prevent coronary heart disease (CHD), but is underused. A simple clinic tool improved appropriate aspirin use, especially in males and nondiabetics, potentially reducing cardiac events.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Practice Improvement
Background:
- Coronary heart disease (CHD) is a leading cause of death.
- Aspirin is proven effective for primary prevention of CHD.
- Physician awareness of aspirin's benefits is low, leading to underutilization.
Purpose of the Study:
- To demonstrate the underuse of aspirin in primary CHD prevention.
- To improve appropriate aspirin utilization through an easy-to-use clinic tool.
- To estimate patient risk for cardiovascular events.
Main Methods:
- Retrospective cohort analysis at a Naval Medical Center Internal Medicine Clinic.
- Screened 494 patients pre-intervention and 593 post-intervention.
- Implemented a poster displaying the Framingham Risk Score and aspirin guidelines.
Main Results:
- A trend toward increased aspirin utilization from 63.5% to 72.8% (P=0.054) was observed.
- Significant improvement in appropriate aspirin use was noted in males (P=0.01) and nondiabetics (P=0.02).
- Demographics were similar, though the post-intervention group had more diabetics.
Conclusions:
- Aspirin is beneficial for primary CHD prevention but remains underutilized.
- Implementing the Framingham Risk Score can streamline decision-making and improve appropriate aspirin use.
- Improved utilization can lead to reduced cardiac events and better patient outcomes.
Objectives:
Coronary heart disease (CHD) is the number one cause of death in adults in the industrialized world, and several large studies show that aspirin is helpful for the primary prevention of this disease. Unfortunately, few physicians are aware of its benefit, resulting in the underutilization of aspirin for the primary prevention of CHD. The purpose of this study was to demonstrate the underuse of aspirin for the primary prevention of CHD, and to improve appropriate utilization by implementing an easy-to-use clinic tool that quickly estimates a patient's risk.
Patients And Methods:
This is a retrospective cohort analysis conducted in the Internal Medicine Clinic in the Naval Medical Center in San Diego, California. Random samples of 494 patients before and 593 after intervention who were followed in the Internal Medicine Clinic were screened. Inclusion criteria were a 10-year risk of myocardial infarction or coronary death of more than 10%, or diabetes with one other cardiac risk factor. A poster was placed in each clinic examination room showing the Framingham Risk Score, the indications for aspirin use, and common contraindications to assist physicians in determining if a patient warranted aspirin for primary prevention of CHD. A physician documented regular use of aspirin, 81 to 325 mg per day.
Results:
Age and sex demographics were similar between the two measurement groups. Diabetics comprised a significantly greater percentage of patients in the postintervention group. There was a trend toward increase in utilization of aspirin from 63.5% to 72.8% (P = 0.054) after our intervention. In subgroup analysis, significant improvement in appropriate aspirin use was found amongst males (P = 0.01) and nondiabetics (P = 0.02).
Conclusion:
Aspirin has proven beneficial in the primary prevention of CHD, but is clearly underutilized in this role. By implementing the Framingham Risk Score to streamline the decision process, appropriate utilization can be improved, and in turn, cardiac events can be reduced and patients can benefit.
Related Concept Videos
01:26Coronary Artery Disease IV: Preventive Measures
01:26Atherosclerosis III: Management
01:27Coronary Artery Disease V: Interprofessional Care
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care