General practitioners' use of aspirin in the secondary prevention of vascular events: knowledge, attitudes, and current practice

Background. Aspirin has been shown to significantly reduce mortality when t aken by patients with vascular disease. Studies in secondary care have show n its use to be suboptimal, but aspirin use among general practitioners (GP s) has not been directly assessed, although some data on aspirin use in the community exists. Little is known about factors that might influence aspir in use by GPs, despite much recent research on the wider issues of followin g evidence-based 'best' practice. Aims. To determine the use of aspirin by GPs in preventing vascular events, and to identify factors influencing its use. Method. Postal questionnaire using clinical vignettes sent to all GPs ident ified from the North Staffordshire Health Authority database. Results. Of 230 questionnaires sent, 123 were returned giving an overall re sponse of 54%. For patients with vascular disease, a median of 86% of GPs a dvised aspirin use, with a range from 80% to 96% according to the site oft he vascular disease. Responses were analysed when an additional diagnosis w as added to the clinical situation. These diagnoses were designed to repres ent conditions in which aspirin may be used, but with caution. For patients falling into this category, the benefits of aspirin prophylaxis usually ou tweigh the risks of aspirin use. The addition of such a diagnosis was assoc iated with a median reduction to 67% of responders who indicated that aspir in would be used (range = 66% to 85%). A contraindication to aspirin reduce d its use to 66% of the sample. In patients without vascular disease but wi th multiple risk factors for future cardiovascular disease, the use of aspi rin ranged from 17% to 54%. There was self-reported confusion among respond ers about what dose and formulation of aspirin to advise and prescribe. Conclusions. The results obtained from the responders may not represent the opinion of all GPs in the North Staffordshire area owing to the low respon se rate. There is, however, stated unwillingness to advise aspirin prophyla xis by some GPs, even when it is clearly indicated. The presence of comorbi dity reduces its use further, regardless of whether this involves a contrai ndication to aspirin or not A substantial proportion of GPs are recommendin g the use of aspirin in patients with risk factors for, but without actual symptoms of, vascular disease. Further education is required to reduce unce rtainty about which formulation and dose of aspirin to use. Recommendations from authorities on the subject should be disseminated and must be practic al and clear. Research into the failure to incorporate quality research int o everyday practice must continue.