Plenary III - National Forum for Heart Disease and Stroke Prevention

Plenary III
Stanton Shanedling, PhD, MPH
Ask About Aspirin
Supervisor, Heart Disease & Stroke Prevention
Unit, Minnesota Department of Health
• Alan T. Hirsch, MD
Professor of Medicine, Epidemiology & Community Health
Director, Vascular Medicine Program, Lillehei Heart Institute,
University of Minnesota - Medical School
• John R. Finnegan, PhD
Professor & Dean, Vice President of Public Health,
University of Minnesota - School of Public Health
• Russell V. Luepker, MD, MS
Mayo Professor of Public Health, Division of Epidemiology &Community Health,
University of Minnesota - School of Public Health
Niki Oldenburg, DrPh
Research Team Leader, Vascular Medicine Program
Goal: Statewide initiative to reduce CVD by promoting a community
intervention to increase the appropriate use of low dose aspirin in
target populations
Utilize United States Preventive
Services Task Force (USPSTF)
aspirin recommendations for the
primary prevention of
cardiovascular disease:
▪▪Encourage men age 45 to 79 years to
use aspirin when the potential benefit of
a reduction in myocardial infarctions
outweighs the potential harm of an
increase in gastrointestinal hemorrhage.
(USPSTF “A” recommendation)
▪▪Encourage women age 55 to 79 years to
use aspirin when the potential benefit of
reduction in ischemic strokes outweighs
the potential harm of an increase in
gastrointestinal hemorrhage. (USPSTF “A”
Baseline data prior to intervention- 2009
• 35% of men age 45-79 and 37% of women age 55-79 reported taking ASA
(MN Heart Survey)
• 19% of all deaths in Minnesota due to Heart Disease (18% in 2011)
• 6% of all deaths in Minnesota due to Stroke (5% in 2011)
Interventions to increase use of low-dose ASA
1. Health Professional Education – reaching physicians, pharmacists, nurses
and other health professionals to disseminate new practice tools to
improve aspirin use in the target patient population
2. Shared Media – engaging the public through the use of on-line resources
to engage adherence to aspirin use;
3. Mass Media – reaching the public via use of traditional mass media,
including television, newspapers, radio station, billboards, etc.
• Increase aspirin intake by an absolute 10% in Minnesota adult population
of men age 45-79 and women age 55-79.
• Reduce the number of first heart attacks and strokes in the target
population in Minnesota.
• Verify the impact of newly developed prevention tools and measure the
effects of the campaign, in order to assure that the most effective tools
can be disseminated across the State of Minnesota, as a national model.
Clinic Based Interventions: Hibbing, MN
Three Health Systems
1. Patient identification and activation
2. Provider and team behavior awareness and
3. Community Systems Change –
Community Health Coordinator
Public Awareness
85% liked the ads
72% found the ads engaging
95% found the ads believable
87% trusted the ads
87% had a favorable reaction
Aspirin Use in Hibbing:
Self-Report and Assay Results
ASA use
Self-reported use
Self-reported daily use
Regularly take aspirin to
prevent MI or stroke
Total Group
Primary Prevention
Secondary Prevention
52 (50.5)
49 (47.6)
50 (48.5)
28 (37.8)
27 (36.5)
26 (35.1)
24 (82.8)
22 (75.9)
Assay results (n=54)
Thromboxane <25ng/ml
Self-reported use*
Self-reported daily use**
36/54 (66.7)
32/54 (59.3)
31/54 (57.4)
23/38 (60.5)
18/38 (47.4)
13/16 (81.3)
14/16 (87.5)
14/16 (87.5)
Before the campaign the primary prevention group rarely asked their
clinician about aspirin use to prevent a heart attack or stroke (less
than 1 in 5 individuals).
Self-Reported Aspirin Use in the Primary
Prevention Cohort
This rate of change is higher than temporal trends
ASA use
Self-reported daily use*
Regularly take aspirin to
prevent MI or stroke
27/74 (37%)
44/85 (52%)
26/74 (35%)
39/85 (46%)
---------- Over four months aspirin use increased ----------
*Answered “daily” to the question “How often do you take aspirin”?
Goals for Next 12 Months
1. Create improved public awareness campaign messages
2. Improve the efficacy of clinic-based ASA use intervention and metrics
> Expand use of the EHR as a tool for medication mgmt and adherence
> Achieve > 90% health professional engagement of ASA primary
prevention learning module
3. The program is prepared to expand to a State or wider intervention in 2014
Some key questions
• Focus on prevention vis a vis intervention messaging?
• Given ABCS why no concerted campaign to support ASA?
• Ambiguity in information exchange?
• Are there concerns?
Alan T. Hirsch, MD
[email protected]
Stanton Shanedling, PhD, MPH
[email protected]
Plenary III
Q and A
Ask About Aspirin

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