Findings Highlight Need For Improved Doctor/ Patient Communication About Important Preventive Therapy
July 14, 2006 — Survey results released by the American College of Preventive Medicine (ACPM) found that nearly half (48 percent) of U.S. adults 40 and over with diabetes are not utilizing aspirin therapy to reduce their risk of recurrent heart attack or stroke nor had they reported discussing such therapy with their healthcare provider.
This population is at heightened risk of cardiovascular (CV) events, and therefore potential candidates for doctor-recommended aspirin therapy based on current American Diabetes Association and U.S. Preventive Services Task Force (USPSTF) guidelines.
Heart attack and stroke are the most life-threatening consequences of diabetes, occurring more than twice as often among people with diabetes than in those who do not have the disease, and accounting for approximately 65 percent of deaths in people with diabetes.
According to the American Diabetes Association (ADA), a diagnosis of diabetes as an adult presents a similar level of coronary heart disease (CHD) risk as already having suffered a heart attack. The ADA recommends that aspirin be considered for use in the prevention of both first and recurrent CV events in patients with diabetes who have at least one additional risk factor. Additionally, the USPSTF recommends the consideration of low-dose aspirin in people whose five-year CHD risk exceeds 3 percent, a point at which the benefits of aspirin therapy are thought to outweigh the risks; the USPSTF recommendations also note that patients with diabetes appear to benefit "as much or more from aspirin as nondiabetic patients."
Despite these treatment guidelines, the ACPM survey suggests that aspirin remains underutilized in people with diabetes, an issue that may be due in part to these individuals' tendency to underestimate their risk for a heart attack or stroke.
"The survey findings suggest that insufficient numbers of Americans with diabetes are aware of the cardio-protective benefits of aspirin," commented George K. Anderson, M.D., MPH, past president of the ACPM. Although the benefits of aspirin therapy have been proven to outweigh the risks in moderate to high risk populations, it is concerning that so many people with diabetes and at least one additional risk factor — a population that would stand to benefit from aspirin use — seem unaware of this fact," said Dr. Anderson. "Clearly, health professionals and patients — especially patients with diabetes age 40 or older — need to work together more closely to improve dialogue regarding aspirin therapy as part of a risk-reduction action plan."
It's important to remember that aspirin is not appropriate for everyone, so be sure to talk to your doctor before you begin an aspirin regimen. If you are taking a prescription product for diabetes, it is especially important to talk to your doctor because aspirin can interfere with certain diabetes medications.
Survey Findings and Implications
The results were drawn from a nationally representative on-line survey of 1,299 U.S. adult consumers (647 men, 652 women) age 40 and over and 528 healthcare professionals. The survey was designed to assess barriers, beliefs and behaviors related to adoption of cardiovascular event prevention strategies, with a particular focus on aspirin use and adherence.
Of the 1,299 survey respondents, 198 (approximately 15 percent) indicated that they have diabetes. Whereas 52 percent of respondents with diabetes reported that they take aspirin on a regular or daily basis, 11 percent said they had previously used aspirin for prevention of heart attack or stroke, and 45 percent said they had never taken aspirin for this purpose. While nearly half of the diabetic respondents said they consider themselves "extremely knowledgeable" about aspirin therapy, only 25 percent of the diabetic respondents said they strongly agree with the statement, "The benefits of aspirin therapy generally outweigh the risks."
The survey findings suggest that healthcare professionals believe they are discussing the risks and benefits of aspirin therapy with their patients with diabetes more frequently than patients report having this discussion with their healthcare provider. Although the survey did not explore the underlying reasons for patient behaviors, there was a significantly smaller percentage of diabetic respondents reporting aspirin use (52 percent), as compared with those reporting implementation of lifestyle changes (86 percent) and use of prescription medication (81 percent).
"Although the survey did not quantify how often healthcare professionals recommended aspirin, or how many patients received this recommendation, the disparity in consumer and professional responses suggests that many candidates for aspirin need to understand their risk and take action by talking to their doctor about aspirin," said Dr. Anderson. "While this is true for the population as a whole, the need for improved physician/patient communication surrounding aspirin is particularly pronounced for individuals with diabetes, given the heightened level of risk and suboptimal utilization in this patient group."
Methodology
Harris Interactive® conducted the online survey October 21 through 29, 2004 among a nationwide crosssection of 1,299 U.S. adults aged 40 and over. The data were weighted to be representative of the total U.S. adult population on the basis of region, age within gender, education, household income, race/ethnicity, and propensity to be online.
Participants were grouped as increased risk using a formula that is based in part on the Framingham Risk Calculator, a simplified measurement tool that assesses an individual's risk profile based upon a series of factors, including age, gender, previous cardiovascular events, presence of risk factors such as high cholesterol, blood pressure or diabetes, obesity, and other contributors such as smoking and family history of heart disease.
The sampling error for the overall results is +/- 3 percentage points. Sampling errors for the subsamples of men is +/- 4 percentage points, women is +/- 4 percentage points, adults who are at an increased risk for heart disease is +/- 4 percentage points, increased risk men is +/- 5 percentage points, increased-risk women is +/- 7 percentage points, increased-risk women who have discussed their heart health with a healthcare professional is +/- 7 percentage points, and increased-risk adults who have not experienced a heart attack is +/- 4 percentage points. This online sample was not a probability sample.
Harris Interactive also conducted a companion survey online from October 21 through November 8, 2004, among 533 healthcare professionals, of whom 212 were primary care physicians, 210 were cardiologists, and 111 were nurses. The primary care physician and cardiologist data were weighted to be representative of their respective populations in the U.S. The nurse data are unweighted and are therefore only representative of the population of nurses surveyed. The nursing database was provided by the Preventive Cardiovascular Nurses Association (PCNA), and consisted of PCNA members. The sampling error for the physician results is +/-7 percentage points and for the nurse results it is +/- 10 percentage points. This online sample is not a probability sample.
A Note on the Results
Survey research, regardless of how it is conducted or whom it surveys, must often be interpreted with caution when analyzing the results. The following caveats apply to this survey. First, many of the questions asked of both the consumer and healthcare professional samples were framed in such a way as to measure whether a certain activity has "ever" been done or discussed. Follow-up questions were not included to quantify the frequency with which these actions are taken. Secondly, the risk calculation used to identify consumers who are at increased risk for heart disease is based solely on information gathered as part of this survey and does not include information from any other sources such as patient medical records. Third, in some cases, questions were worded such that "heart attack" and "stroke" were combined into one item rather than being asked about separately (e.g., a response choice for one question was worded as "preventing heart attack or stroke"). Therefore, it is not possible to determine how respondents would answer for each cardiac event separately.
Editor's note: The survey, which was conducted by Harris Interactive® in collaboration with the ACPM, was supported by an unrestricted educational grant from Bayer HealthCare, the makers of Bayer Aspirin.
