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Implementation of a Pharmacist-Driven Aspirin Deprescribing Protocol Among Older Veterans in a Primary Care Setting
Christy Johny Varghese1, Mike Grunske2, Michael W Nagy2
11 Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.
Insights
Pharmacist-led aspirin deprescribing significantly reduced aspirin use in older adults compared to provider education alone. This intervention is effective for primary prevention of atherosclerotic cardiovascular disease (ASCVD).
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Recent guidelines advise against aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in older adults.
- Aspirin use persists in this demographic despite guideline changes.
- Veterans Health Administration (VHA) primary care settings present an opportunity for intervention.
Purpose of the Study:
- To compare a pharmacist-driven aspirin deprescribing protocol against primary care provider (PCP) education alone.
- To evaluate the effectiveness of pharmacist intervention in reducing aspirin prescriptions for primary ASCVD prevention.
Main Methods:
- A prospective cohort study at a VHA medical center involving patients aged 70+ prescribed aspirin for primary ASCVD prevention.
- Intervention group received pharmacist-led deprescribing and PCP education; control group received PCP education only.
- Exclusion criteria included aspirin from external sources, non-ASCVD indications, or prior ASCVD history.
Main Results:
- The pharmacist-led deprescribing group achieved a significantly higher rate of aspirin deprescriptions (54%) compared to the education-only group (18%; P = 0.0001).
- Sixty-five patients meeting criteria were contacted for deprescribing.
- The study targeted 520 patients in the intervention group versus 417 in the control group.
Conclusions:
- A pharmacist-led aspirin deprescribing protocol is highly effective in primary care settings.
- This approach significantly decreases aspirin prescriptions for primary ASCVD prevention compared to standard PCP education.
- The findings support integrating pharmacists into deprescribing initiatives for guideline-adherent care.
Abstract:
Background Recent cardiovascular guideline updates recommend against the use of aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in older people. However, aspirin use remains common in this population. Objective To implement and evaluate the benefit of a pharmacist-driven aspirin deprescribing protocol compared with primary care provider (PCP) education-only in a primary care setting. Methods This prospective, cohort project targeted deprescribing for patients prescribed aspirin for primary prevention of ASCVD. Patients were included if they received primary care services at the Milwaukee Veterans Health Administration Medical Center (VHA) and were 70 years of age or older. Criteria for exclusion were aspirin obtained outside the VHA system, aspirin prescribed for a non-ASCVD-related condition, and/or a history of ASCVD. Active deprescribing by pharmacists and PCP education took place in the intervention group with PCP education only in the standard-of-care group. The primary outcome was the proportion of patients who had aspirin deprescribed in each group. Secondary outcomes included patient acceptability of the intervention and barriers to implementation. Results A total of 520 patients were prescribed aspirin in the intervention group versus 417 in the education-only group. Sixty-five patients met intervention criteria and were contacted for aspirin deprescribing. The pharmacist-led active deprescribing group led to a higher rate of aspirin deprescriptions versus the education-only group (54% vs 18%; P = 0.0001) for patients who met criteria. Conclusion A pharmacist-led aspirin deprescribing protocol within a primary care setting significantly decreased the number of aspirin prescriptions compared with PCP education only.
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