An increase in effective low-dose aspirin use for prevention of heart disease was not seen following a massive multiyear media campaign and clinic education intervention aimed at improving guideline-based use, according to study results published in the Journal of the American Medical Association Network Open.
Researchers sought to investigate the possibility of enhancing guideline adherence for low-dose aspirin use, with the primary endpoint of improvement in correct use or non-use of low-dose aspirin according to 2009 United States Preventive Service Task Force guidelines.
To accomplish this, they conducted the Ask About Aspirin project (ClinicalTrials.gov identifier: NCT02607917), a nonrandomized, controlled trial that took place in Minnesota from July 2015 through March 2020. This trial targeted adults and primary care clinics utilizing digital media, as well as traditional media, and professional education to improve guideline-based low-dose aspirin use. Controls were the 4 adjacent states. At baseline, 2 years, and 4 years after project initiation, researchers conducted cross-sectional random telephone surveys of 8342 men (45-79 years of age) and women (55-79 years of age). A questionnaire was incorporated to evaluate low-dose aspirin use.
There were more than 1 million visits to the Ask About Aspirin website, and more than 1000 clinicians from 124 primary care clinics underwent the education program, the result of which were nonsignificant increases in discussions with the clinicians in reference to aspirin (baseline: 34%; year 4: 36%; P =.27). New Preventive Service Task Force guidelines in 2016 combined with 3 clinical trials in 2018 suggesting reduced aspirin use, seemed to undercut this study as overall aspirin use decreased (baseline: 41%; year 4: 34%; P <.001) and correct usage also decreased from year 2 to year 4 (year 2: 49%; year 4: 40%; P <.001) and overuse decreased (year 2: 28%; year 4: 23%; P =.04). No significant differences were seen between any of the controls and low-dose aspirin usage in Minnesota.
Study limitations included the underexposure of the target audience to the intervention campaign, response bias in the use of landlines only, spillover contamination of the population in control states living near Minnesota borders, and the internet refused to stop at Minnesota state boundaries thus allowing anyone to access the Ask About Aspirin website.
Researchers concluded that there was no association between the massive media campaign and increased appropriate aspirin use for prevention of heart disease. They noted, “These findings suggest that although education programs using social media for cardiovascular disease prevention can result in millions of hits, the use of this strategy to encourage behavior change is problematic, even with supportive clinical sites.”
Luepker RV, Eder M, Finnegan JR, Van’t Hof JR, Oldenburg N, Duval S. Association of a community population and clinic education intervention program with guideline-based aspirin use for primary prevention of cardiovascular disease: A nonrandomized controlled trial. JAMA Netw Open. Published online May 10, 2022. doi:10.1001/jamanetworkopen.2022.11107