Reconsidering low-dose aspirin therapy for cardiovascular disease: a study protocol for physician and patient behavioral change
Open accessAbstract
Background: There are often disparities between current evidence and current practice. Decreasing the gap between desired practice outcomes and observed practice outcomes in the healthcare system is not always easy. Stopping previously recommended or variably recommended interventions may be even harder to achieve than increasing the use of a desired but under-performed activity. For over a decade, aspirin has been prescribed for primary prevention of cardiovascular disease and for patients with the coronary artery disease risk equivalents; yet, there is no substantial evidence of an appropriate risk-benefit ratio to support this practice. This paper describes the protocol of a randomized trial being conducted in six primary care practices in the Denver metropolitan area to examine the effectiveness of three interventional strategies to change physician behavior regarding prescription of low-dose aspirin. Methods: All practices received academic detailing, one arm received clinician reminders to reconsider aspirin, a second arm received both clinician and patient messages to reconsider aspirin. The intervention will run for 15 to 18 months. Data collected at baseline and for outcomes from an electronic health record will be used to assess pre- and post-interventional prescribing, as well as to explore any inappropriate decrease in aspirin use by patients with known cardiovascular disease. Discussion: This study was designed to investigate effective methods of changing physician behavior to decrease the use of aspirin for primary cardiovascular disease prevention. The results of this study will contribute to the small pool of knowledge currently available on the topic of ceasing previously supported practices. Trial Registration: ClinicalTrials.gov: NCT01247454
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Across diverse fields, reasonable consensus has developed about when particular designs should be used and what sample size and design protocols are needed to maximize internal validity.
“Within this growing family of randomized, nonrandomized, and mixed method designs, reasonable consensus has grown across diverse fields about when certain designs should be used and what sample size requirements and design protocols are necessary to maximize internal validity (42, 87).”
From An Overview of Research and Evaluation Designs for Dissemination and Implementation (2017) · cites this paper as [42]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study
D’Agostino, R. B., Vasan, R. S., Pencina, M. J., Wolf, P. A., Cobain, M., Massaro, J. M., & Kannel, W. B. (2008) · Circulation · doi:10.1161/circulationaha.107.699579 · Cited by 7,491 · see citing works
Why Don't Physicians Follow Clinical Practice Guidelines?: A Framework for Improvement
Cabana, M. D., Rand, C. S., Powe, N. R., Wu, A. W., Wilson, M. H., Abboud, P.-A. C., & Rubin, H. R. (1999) · JAMA · doi:10.1001/jama.282.15.1458 · Cited by 6,677 · see citing works
Hansson, L., Zanchetti, A., Carruthers, S. G., Dahlöf, B., Elmfeldt, D., Julius, S., Ménard, J., Rahn, K. H., Wedel, H., & Westerling, S. (1998) · The Lancet · doi:10.1016/s0140-6736(98)04311-6 · Cited by 5,728 · see citing works
Bero, L. A., Grilli, R., Grimshaw, J. M., Harvey, E., Oxman, A. D., & Thomson, M. A. (1998) · BMJ · doi:10.1136/bmj.317.7156.465 · Cited by 2,396 · see citing works
Final Report on the Aspirin Component of the Ongoing Physicians' Health Study
Steering Committee of the Physicians' Health Study Research Group (1989) · New England Journal of Medicine · doi:10.1056/nejm198907203210301 · Cited by 2,269 · see citing works
A Randomized Trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women
Ridker, P. M., Cook, N. R., Lee, I.-M., Gordon, D., Gaziano, J. M., Manson, J. E., Hennekens, C. H., & Buring, J. E. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa050613 · Cited by 1,945 · see citing works
Oxman, A. D., Thomson, M., Davis, D. A., & Haynes, R. B. (1995) · PubMed Central · Cited by 1,847 · see citing works
Hunt, D. L., Haynes, R. B., Hanna, S., & Smith, K. (1998) · JAMA · doi:10.1001/jama.280.15.1339 · Cited by 1,684 · see citing works
Primary Prevention of Ischemic Stroke
Goldstein, L. B., Adams, R. J., Alberts, M. J., Appel, L. J., Brass, L. M., Bushnell, C., Culebras, A., DeGraba, T. J., Gorelick, P. B., Guyton, J. R., et al. (2006) · Stroke · doi:10.1161/01.str.0000223048.70103.f1 · Cited by 1,359 · see citing works
(1997) · Europe PMC (PubMed Central) · Cited by 1,226 · see citing works
Low-Dose Aspirin for the Prevention of Atherothrombosis
Patrono, C., Rodríguez, L. A. G., Landolfi, R., & Baigent, C. (2005) · New England Journal of Medicine · doi:10.1056/nejmra052717 · Cited by 1,211 · see citing works
Randomised trial of prophylactic daily aspirin in British male doctors
Peto, R., Gray, R. G., Collins, R., Wheatley, K., Hennekens, C. H., Jamrozik, K. D., Warlow, C., Hafner, B., Thompson, E., Norton, S., et al. (1988) · BMJ · doi:10.1136/bmj.296.6618.313 · Cited by 1,164 · see citing works
Belch, J., MacCuish, A., Campbell, I., Cobbe, S., Taylor, R., Prescott, R., Lee, R., Bancroft, J., MacEwan, S., Shepherd, J., et al. (2008) · BMJ · doi:10.1136/bmj.a1840 · Cited by 977 · see citing works
Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men
Berger, J. S., Roncaglioni, M. C., Avanzini, F., Pangrazzi, I., Tognoni, G., & Brown, D. (2006) · JAMA · doi:10.1001/jama.295.3.306 · Cited by 781 · see citing works
Johnston, M. E., Langton, K. B., Haynes, R. B., & Mathieu, A. (1994) · Annals of Internal Medicine · doi:10.7326/0003-4819-120-2-199401150-00007 · Cited by 713 · see citing works
Hayden, M., Pignone, M. P., Phillips, C. J., & Mulrow, C. D. (2002) · Annals of Internal Medicine · doi:10.7326/0003-4819-136-2-200201150-00016 · Cited by 622 · see citing works
Shea, S., DuMouchel, W., & Bahamonde, L. (1996) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.1996.97084513 · Cited by 542 · see citing works
U.S. Preventive Services Task Force* (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-150-6-200903170-00008 · Cited by 533 · see citing works
Bloom, B. S. (2005) · International Journal of Technology Assessment in Health Care · doi:10.1017/s026646230505049x · Cited by 480 · see citing works
Changing physicians' behavior: What works and thoughts on getting more things to work
Grimshaw, J., Eccles, M., Walker, A. E., & Thomas, R. E. (2002) · Journal of Continuing Education in the Health Professions · doi:10.1002/chp.1340220408 · Cited by 454 · see citing works
Colwell, J. A. (1997) · Diabetes Care · doi:10.2337/diacare.20.11.1767 · Cited by 402 · see citing works
Sacco, M., Pellegrini, F., Roncaglioni, M. C., Avanzini, F., Tognoni, G., Nicolucci, A., & on behalf of the PPP Collaborative Group (2003) · Diabetes Care · doi:10.2337/diacare.26.12.3264 · Cited by 381 · see citing works
Evidence for the Effectiveness of Techniques To Change Physician Behavior
Smith, W. R. (2000) · CHEST Journal · doi:10.1378/chest.118.2_suppl.8s · Cited by 239 · see citing works
(1998) · PubMed · Cited by 200 · see citing works
A survey of factors affecting clinician acceptance of clinical decision support
Sittig, D. F., Krall, M., Dykstra, R. H., Russell, A., & Chin, H. L. (2006) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-6-6 · Cited by 138 · see citing works
Ethier, J. H., Bragg‐Gresham, J. L., Piera, L., Akizawa, T., Asano, Y., Mason, N. A., Gillespie, B. W., & Young, E. W. (2007) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2007.07.007 · Cited by 126 · see citing works
American Diabetes Association (2003) · Diabetes Care · doi:10.2337/diacare.26.2007.s87 · Cited by 122 · see citing works
Barriers to translating evidence into practice
Berenholtz, S. M., & Pronovost, P. J. (2003) · Current Opinion in Critical Care · doi:10.1097/00075198-200308000-00012 · Cited by 111 · see citing works
Bushnell, C., Culebras, A., DeGraba, T. J., Goldstein, B. A., Adams, R. J., Alberts, M. J., & Appel, L. J. (2006) · Cited by 108 · see citing works
Elson, R. B. (1995) · Archives of Family Medicine · doi:10.1001/archfami.4.8.698 · Cited by 103 · see citing works
Effect of physician reminders on preventive care: meta-analysis of randomized clinical trials.
Austin, S., Balas, E. A., Mitchell, J. A., & Ewigman, B. (1994) · PubMed Central · Cited by 93 · see citing works
Meta-Analysis of Data from the Six Primary Prevention Trials of Cardiovascular Events Using Aspirin
Bartolucci, A. A., & Howard, G. (2006) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2006.04.012 · Cited by 91 · see citing works
Clinical guidelines in primary care: a survey of general practitioners' attitudes and behaviour.
Siriwardena, A. N. (1995) · PubMed · Cited by 72 · see citing works
General practitioners and clinical guidelines: a survey of knowledge, use and beliefs.
Newton, J., Knight, D., & Woolhead, G. (1996) · PubMed · Cited by 54 · see citing works
Poolman, R. W., Verheyen, C. C. P. M., Kerkhoffs, G. M. M. J., Bhandari, M., & Schünemann, H. J. (2009) · Acta Orthopaedica · doi:10.1080/17453670902807458 · Cited by 37 · see citing works
One Size Does Not Fit All: Questions to Answer Before Intervening to Change Physician Behavior
Poses, R. M. (1999) · The Joint Commission Journal on Quality Improvement · doi:10.1016/s1070-3241(16)30463-1 · Cited by 35 · see citing works
Report From the 100th Cardiovascular and Renal Drugs Advisory Committee Meeting
Fleming, T., Nissen, S. E., BORER, J. S., & Armstrong, P. W. (2004) · Circulation · doi:10.1161/01.cir.0000118364.89571.16 · Cited by 11 · see citing works
Gronseth, G. (2004) · NeuroRx · doi:10.1602/neurorx.1.3.331 · Cited by 8 · see citing works
Flagged first, then by citations
1 of the 42 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
An Overview of Research and Evaluation Designs for Dissemination and Implementation
Brown, C. H., Curran, G., Palinkas, L. A., Aarons, G. A., Wells, K. B., Jones, L., Collins, L. M., Duan, N., Mittman, B. S., Wallace, A., et al. (2017) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031816-044215 · Cited by 509 · see citing works
Aspirin overutilization for the primary prevention of cardiovascular disease
VanWormer, J. J., Miller, A., & Rezkalla, S. H. (2014) · Clinical Epidemiology · doi:10.2147/clep.s72032 · Cited by 22 · see citing works
Hissett, J., Folks, B., Coombs, L., LeBlanc, W., & Pace, W. D. (2014) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2014.01.130030 · Cited by 12 · see citing works
Self-citationEvaluation of a Pharmacist-Driven Ambulatory Aspirin Deprescribing Protocol
Rothbauer, K. (2022) · Federal Practitioner · doi:10.12788/fp.0294 · Cited by 4 · see citing works
Chen, L., & Yao, W. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1737644 · Cited by 1 · see citing works
- Authors
- Folks, B., LeBlanc, W. G., Staton, E. W., & Pace, W. D.
- Affiliations
- University of Colorado Denver (US)
- Corresponding author
- Staton, Elizabeth W
- Venue
- Implementation Science
- Published
- 2011-06-26
- Volume
- 6
- Issue
- 1
- Pages
- 65-65
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC3141566
- OpenAlex
- W2163363279
- Cited by
- 5
- References
- 42
- Citations by year
- 2026: 1 · 2022: 1 · 2017: 1 · 2014: 2
- FWCI
- 0.63
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Keywords
- low-dose aspirin, aspirin prescribing, primary prevention of cardiovascular disease, physician behavior change, academic detailing, knowledge-practice gap, primary care, electronic health records
- MeSH terms
- Aspirin, Cardiovascular Diseases, Clinical Protocols, Colorado, Coronary Artery Disease, Decision Support Techniques, Education, Medical, Continuing, Humans, Practice Patterns, Physicians'
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
