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Goals of the Roundtable

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Goals of the Roundtable

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  1. Bringing Science to Practice: Therapy Underutilization and Compliance in CV disease - The Aspirin Perspective Aspirin underuse, poor compliance and cessationGiuseppe Biondi-Zoccai, MDSapienza University of Rome, Latina, ItalyMelbourne, May 6, 2014 – 16:00 to 19:00 - Room M14, Crown Promenade

  2. Goalsof the Roundtable • Prevalence of non-adherence to Aspirin • Consequences of non-compliance/discontinuation to Aspirin • Issues surrounding non-compliance to Aspirin • Tools and programs to improve compliance to Aspirin

  3. Toooldtobegood?

  4. Toogoodtobetrue?

  5. Do westillneed Aspirin?

  6. What are the facts?

  7. Goalsof the Presentation • Underutilisation and poor adherence in secondary prevention of CVD • Physician and patient perceptions about Aspirin • Impact of Aspirin discontinuation (including inconsistent use and temporary discontinuation)

  8. Updatedterminology • Cessation: anyceasing or discontinuance • Compliance: accuracy with which a patient follows an agreed treatment plan • Discontinuation: physician-supervised withdrawal as perceived as no longer needed • Disruption: cessation due to non-compliance or bleeding (brief: 1-5 days; temporary: 6-30 days; permanent: >30 days) • Interruption: physician-supervised temporary discontinuation for surgery lasting <15 days • Underuse: act of using (or prescribing) less than expected Mehranet al, Lancet 2013;382:1714-22

  9. Aspirin use in US secondaryprevention George MG et al, MMWR MorbMortalWklyRep 2012;61 Supp:11-8

  10. Self-reported Aspirin underuseamongUS patientswithestablishedindication Rivera et al, J Womens Health (Larchmt) 2012;21:379-87

  11. Aspirin compliance in Europe-Latin America Zaninelliet al, PostgradMed 2009;121:44-53

  12. Aspirin compliance in Asia-Pacific Zaninelliet al, PostgradMed 2010;122:108-17

  13. Focus on post-ACS in China: the BRIG study Niuet al, Am Heart J 2009;157:709-15.e1

  14. Goalsof the Presentation • Underutilisation and poor adherence in secondary prevention of CVD • Physician and patient perceptions about Aspirin • Impact of Aspirin discontinuation (including inconsistent use and temporary discontinuation)

  15. Aspirin forprimaryprevention in women Ridkeret al, for the Women HealthStudyInvestigators, New Engl J Med 2005;352:1293-304

  16. Aspirin forprimaryprevention in men Physicians’ HealthStudyInvestigators, New Engl J Med 1989;321:129-35

  17. Impact on fatal/non-fatalcolorectalcancer Rothwellet al, Lancet 2010;376:1741-50

  18. Benefits vs harms Patrono et al, Eur Heart J 2013

  19. Some remainskeptical Clelandet al, Eur Heart J 2013;34:3412-8

  20. Differencesbetween US and Europe Wolffet al, AnnInternMed 2009

  21. Differencesbetween US and Europe Perket al, Eur Heart J 2012

  22. Underuse in US ambulatory care Staffordet al, PLoSMed 2005;2:e353

  23. Causesofunderuse Pignone et al, Am J PrevMed 2007;32:403-7

  24. Non-compliance vs discontinuation Herlitzet al, Am J Cardiovasc Drugs 2010;10:125-41

  25. Perceptions on Aspirin in Europe-Latin America Zaninelliet al, PostgradMed 2009;121:44-53

  26. Perceptions on Aspirin in Asia-Pacific Zaninelliet al, PostgradMed 2010;122:108-17

  27. Meanstoimprovecompliance Zaninelliet al, PostgradMed 2009;121:44-53

  28. Goalsof the Presentation • Underutilisation and poor adherence in secondary prevention of CVD • Physician and patient perceptions about Aspirin • Impact of Aspirin discontinuation (including inconsistent use and temporary discontinuation)

  29. Ominous impact ofaspirindiscontinuation Biondi-Zoccaiet al, Eur Heart J 2006;27:2667-74

  30. Discontinuationafterstenting Rossini et al, Am J Cardiol 2011;107:186-94

  31. Impact DAPT discontinuationafterstenting MYOCARDIAL INFARCTION CARDIAC DEATH Mehranet al, Lancet 2013;382:1714-22

  32. Discontinuation in UK primary care Rodriguez et al, BMJ 2011;343:d4094

  33. Discontinuation: thrombotic vs bleedingevents Cea Soriano et al, ThrombHaemost 2013;110:1298-304

  34. Avoidingdiscontinuationisalsocheaper Cea Soriano et al, ThrombHaemost 2013;110:1298-304

  35. Take home messages • Differentiatingbetweentype, reason, setting and timing ofunderuse and discontinuationof Aspirin iscrucial • Inadequatephysician-patientcommunication and lackofawarenessofunderlyingcardiovascularrisk and benefits are the key reasonsfor Aspirin underuse and discontinuation • Underuse and discontinuation are clearlydetrimentalforpatients, especiallyearlyafteran acute cardiovascularevent or procedure, butevenlater on

  36. Manythanksforyourattention Foranyquery: giuseppe.biondizoccai@uniroma1.it gbiondizoccai@gmail.com Forthese and otherslides:http://www.metcardio.org/slides.html

  37. Reserveslides

  38. ASPREE • ASPREE is a randomised, double-blind placebo trial of 5-year low-dose (100mg) aspirin for 5 years • It involves both males and females, 70 years and older • The study is recruiting 19,000 healthy participants through regional centres (both in urban and rural locations throughout Australia and the United States) • The trial has a number of sub-studies, which investigate the effect of aspirin on specific diseases: Biobank, ENVIS-ion, ALSOP, SNORE-ASA, ASPREE-AMD, ASPREE-Knee, and ASPREE-NEURO • Results are expected for 2018 http://www.aspree.org/AUS/aspree-content/aspree-study-details/about-aspree.aspx

  39. Aspirin: a measureofqualityof care? Quality of health care according to the US Institute of Medicine: degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with professional knowledge

  40. Aspirin discontinuation: a hot topic Biondi-Zoccaiet al, BMJ 2011;343:d3942

  41. Focus on terminology Mehranet al, Lancet 2013;382:1714-22

  42. Delayedanti-cancereffects Burnet al, Lancet 2011;378:2081-7

  43. Aspirin as key componentofpolypills Waldet al, BMJ 2003;326:1419

  44. Complianceaccordingtoindication * *with 102 (18%) reportingaspirinuse VanWormeret al, J FamPract 2012;61:525-32

  45. Some remainskeptical Sutcliffeet al, PLoS ONE 2013;8:e81970

  46. Aspirin use in US primaryprevention George MG et al, MMWR MorbMortalWklyRep 2012;61 Supp:11-8

  47. Self-reported Aspirin underuse Rivera et al, J Womens Health (Larchmt) 2012;21:379-87

  48. Underuse in US ambulatory care Staffordet al, PLoSMed 2005;2:e353

  49. Self-reported Aspirin underuse Rivera et al, J Womens Health (Larchmt) 2012;21:379-87

  50. Focus on post-MI in China: the BRIG study Niuet al, Am Heart J 2009;157:709-15.e1

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