springer, Sydney
(2019)
Prevalence of Aspirin Receipt and Discontinuation Amongst Veterans Health Administration Community Living Center Residents with Indications for Secondary Prevention of Cardiovascular Events.
Master's Thesis, University of Pittsburgh.
(Unpublished)
Abstract
Background: Continuation of aspirin for secondary prevention (ASP) in patients with limited life expectancy and/or advanced dementia (LLE/AD) is controversial, given increased risks and unclear evidence about continued benefits; yet little is known about patterns of use of ASP in this population. This study aimed to 1) describe prevalence and predictors of ASP amongst Veterans at admission to Veterans Affairs (VA) Community Living Centers (CLCs) and 2) assess cumulative incidence and factors predicting aspirin discontinuation within 90 days after admission to a VA CLC.
Methods: We performed a retrospective cohort study in Veterans with LLE/AD admitted to a VA CLC for ≥7 days in fiscal years 2009-15, who had history of coronary artery disease and/or stroke. ASP was defined as receipt of a preventive dose (25-325 mg daily) on ≥1 day in the first 7 days of the stay. Resident, caregiver, and facility level characteristics were extracted from admission Minimum Dataset (MDS) assessments, VA Corporate Data Warehouse, and Medicare claims. Multivariable logistic regression was used to determine factors associated with ASP at CLC admission. Fine and Gray subdistribution hazard models with death as a competing risk were used to identify predictors of aspirin discontinuation.
Results: The sample (n=37,165 CLC episodes) was 98% male, 78% white, and 35% aged 85 year; 48% received aspirin in the first week of the CLC stay. The strongest predictor of higher odds of ASP was having a myocardial infarct in the last year (aOR=1.99, 95% CI=1.79-2.22). A total of 13,844 episodes qualified for the discontinuation analysis; cumulative incidence of ASP discontinuation was 33% by day 91 of the CLC stay. Strong predictors of aspirin discontinuation were documentation of limited prognosis or hospice use (aSDHR 1.90, 95% CI 1.67-2.14) and greater ADL dependency.
Conclusion: Just under half of older adults with LLE/AD used ASP at CLC admission, and a third of those discontinued ASP in the first 91 days. Wide variability in aspirin prescribing may reflect the unclear role of aspirin in end-of-life amongst prescribers. Given the controversy of continuing ASP at end-of-life, future research should assess outcomes of ASP discontinuation in this population.
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| Item Type: |
University of Pittsburgh ETD
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| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
8 April 2019 |
| Defense Date: |
20 March 2019 |
| Approval Date: |
16 April 2019 |
| Submission Date: |
11 April 2019 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
101 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Pharmacy > Pharmaceutical Sciences |
| Degree: |
MS - Master of Science |
| Thesis Type: |
Master's Thesis |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
end-of-life, aspirin, pharmacotherapy, deprescribing |
| Date Deposited: |
16 Apr 2019 17:20 |
| Last Modified: |
16 Apr 2019 17:20 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/36452 |
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