Underutilization of Antiplatelet Therapy for Primary Prevention by Hospitalists

1University of South Florida, Tampa, FL
2University of South Florida, Tampa, FL

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 90

Background:

Many guidelines recommend aspirin for primary prevention of myocardial infarction and cerebrovascular accidents in high‐risk patients. Aspirin use has increased in indicated populations; however, the percentage is still suboptimal. Currently, data from the 1993 to 2003 U.S. National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey estimates the proportion of patient visits in which aspirin use was reported was 32.8%. The objective of this retrospective chart review is to assess the incidence of prescription for antiplatelet therapy by hospitalists for primary prevention.

Methods:

This study was a retrospective chart review of patients admitted from January to June 2006 at a tertiary‐care urban medical center where hospitalists are involved in 40% of patient care. Patients enrolled had to be more than 40 years old with diabetes and hypertension and admitted to an internal medicine hospitalist service. Exclusion criteria included a complaint of chest pain on admission or during the admission; prior or new diagnosis of coronary artery disease; prior or new diagnosis of peripheral vascular disease including cerebrovascular accident; contraindications to antiplatelet therapy including prior history of bleeding, thrombocytopenia, allergy, or adverse side effects; current anticoagulation with warfarin; and irondeliciency anemia. Descriptive statistics were used to analyze the data.

Results:

One hundred and nineteen charts were eligible for review, Only 9 patients (7.6%) were started on antiplatelet therapy; 8 patients initiated on aspirin and 1 patient initiated on clopidogrel. The average age of patients initiated on antiplatelet therapy was 60 years, with an age range from 47 to 73 years old. In this group initiated on anliplatelet therapy, 7 were female and 2 were male. In addition, 6 of 9 patients were on insulin for their diabetes, The average number of antihypertensive medications per patient was 1,7 in the group started on antiplatelet therapy.

Conclusions:

Although the data regarding the benefit of antiplatelet therapy for primary prevention is evolving, many guidelines still recommend antiplatelet therapy for primary prevention of myocardial infarction and stroke in high‐risk groups. As demonstrated by this retrospective chart review, the incidence of initiation of antiplatelet therapy by hospitalists in high‐risk patients is low. For many patients in the U.S. health care system, contact with a hospitalist may be their only source of “primary care.” Thus, hospitalists have an opportunity to contribute to the provision of services generally delegated to the ambulatory setting such as preventive care. As the field of hospital medicine is evolving, hospitalists should be encouraged to recognize their role in the broader scope of patient care.

Author Disclosure:

C. Mai, none; C. Matcja, none.

To cite this abstract:

Mai C, Mateja C. Underutilization of Antiplatelet Therapy for Primary Prevention by Hospitalists. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 90. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/underutilization-of-antiplatelet-therapy-for-primary-prevention-by-hospitalists/. Accessed August 18, 2019.

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