Aspirin Therapy for Primary Prevention of CVD and Colorectal Cancer

Description

Presents aspirin therapy recommendations for adults 50-69 years old with a >=10% 10-Year CVD risk score

Creation Date
Version
0.1.3
Unique Identifier
CDS 008
Status
Experimental
True

Artifact Creation and Usage

Contributors

This artifact was developed by MITRE software engineers and clinical informaticists, in collaboration with clinical subject matter experts and leaders from the USPSTF.

Additional information about the USPSTF's preventive health expertise is available here.

Additional information about MITRE's health expertise is available here.

If you would like further information, would like to give us feedback, or have any questions about this artifact, please contact us at ClinicalDecisionSupport@ahrq.hhs.gov.

IP Attestation The author asserts that this artifact has been developed in compliance with the intellectual property rights attributed to the source material.
Copyrights

Copyright is held by USPSTF and administered by AHRQ.

Repository Information
Approval Date
Publication Date
Last Review Date
Knowledge Level

Semi-structured text that describes the recommendations for implementation in CDS

Purpose and Usage
Purpose

Provides an evidence-based recommendation for aspirin therapy to mitigate a patient's elevated risk of developing CVD and/or colorectal cancer

Intended Population

This artifact applies to adults aged 50 years or older without known CVD (including history of MI or stroke) or colorectal cancer

Usage

This artifact is intended to be used by providers while delivering care in an outpatient setting

Cautions

Implementation details: As specified, this artifact includes CDS interventions and actions for Grade B and C USPSTF recommendations. The CDS implementer can adjust the age parameters to include one or both recommendation statements, if desired.

This artifact is intended for use in outpatient settings only and should not be used in acute care settings.

Additional information and resources: CDS Connect artifacts are not “standalone” and are not intended to be completely plug-and-play (i.e., healthcare systems will need to integrate each artifact with components of their health information technology (IT) system for the artifact to work. CQL Services, an open source publicly-available tool that facilitates integration of CQL code with a health IT system, can be used by organizations that build out a coded expression of this artifact for pilot implementation in their healthcare organization. CQL Services is available here: https://github.com/AHRQ-CDS/AHRQ-CDS-Connect-CQL-SERVICES. Implementers should conduct extensive testing, including clinical testing in real-life workflows, of all artifacts. It is expected that artifacts will be customized and adapted to local clinical and IT environments.

Supporting Evidence
Source Description

Derived from USPSTF Recommendation Statement: Aspirin Therapy for Primary Prevention of Cardiovascular Disease and Colorectal Cancer

References

Bibbins-Domingo, Kirsten on behalf of the United States Preventive Task Force. 2016. Aspirin Therapy for Primary Prevention of CVD and Colorectal Cancer: United States Preventive Task Force Recommendation Statement. Annals of Internal Medicine. 12 April 2016. doi:10.7326/M16-0577.

United States Preventive Services Task Force. 2016. Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medicine. Accessed here.

Recommendation

The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years. (Grade B Recommendation) Source: Ann Intern Med. doi:10.7326/M16-0577

 

Strength of Recommendation

Grade B

Quality of Evidence

"The USPSTF commissioned 3 systematic evidence reviews and a decision-analysis model to develop its recommendation on aspirin use to prevent CVD and cancer. The systematic review on aspirin use to prevent CVD is an update of the 2009 USPSTF review. The systematic review on aspirin use to prevent CRC is an update of the 2007 USPSTF review. The systematic review on aspirin use to prevent cancer other than CRC is new. A review of potential harms was incorporated across all 3 systematic reviews. The primary studies of interest for all reviews focused on primary prevention of CVD. Findings from the 3 coordinated systematic reviews were integral to determining the parameters and assumptions used in the decision-analysis model, which was used to estimate net benefit for the recommendation." Source: Ann Intern Med. doi:10.7326/M16-0577

Recommendation


The decision to initiate low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 60 to 69 years who have a 10% or greater 10-year CVD risk should be an individual one. Persons who are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years are more likely to benefit. Persons who place a higher value on the potential benefits than the potential harms may choose to initiate low-dose aspirin. (Grade C Recommendation). Source: Ann Intern Med. doi:10.7326/M16-0577

Strength of Recommendation

Grade C

Quality of Evidence

"The USPSTF commissioned 3 systematic evidence reviews and a decision-analysis model to develop its recommendation on aspirin use to prevent CVD and cancer. The systematic review on aspirin use to prevent CVD is an update of the 2009 USPSTF review. The systematic review on aspirin use to prevent CRC is an update of the 2007 USPSTF review. The systematic review on aspirin use to prevent cancer other than CRC is new. A review of potential harms was incorporated across all 3 systematic reviews. The primary studies of interest for all reviews focused on primary prevention of CVD. Findings from the 3 coordinated systematic reviews were integral to determining the parameters and assumptions used in the decision-analysis model, which was used to estimate net benefit for the recommendation." Source: Ann Intern Med. doi:10.7326/M16-0577

Artifact Decision Notes

Decision notes are included in the Implementation Guide.

 

Artifact Representation
Triggers
Trigger Type Data event
Trigger Event A new 10-Year CVD risk score is documented in an outpatient setting
Inclusions
Patient is >=50 and <=69 years of age
AND
MOST RECENT 10-Year CVD risk score >=10% in the past 6 years
Exclusions
Diagnosis of CVD
OR Diagnosis of Colorectal Cancer
OR Currently receiving aspirin (at any dose)
OR Ordered or receiving palliative care
OR Aspirin Allergy
OR evidence of increased risk of bleeding, represented by:
      Diagnosis of Active GI bleed
      OR Diagnosis of Active GI ulcers
      OR Diagnosis of bleeding disorders
      OR Diagnosis of ESRD OR Dialysis within the past 7 days
      OR Diagnosis of Cirrhosis or MOST RECENT ALT > 150
      OR Diagnosis of Thrombocytopenia
      OR Currently receiving an Anticoagulant
      OR Currently receiving NSAIDs
      OR MOST RECENT SBP >= 160 mmHg
Interventions and Actions
Intervention

NOTIFY provider that aspirin therapy is recommended.


1) If CVD risk score >=10% and patient age 50-59 (Grade B):
Recommendation: Discuss aspirin 81mg po daily if patient is NOT at high risk for bleeding
Rationale: CVD risk score >10% and age 50-59 without evidence of exclusions


2) If CVD risk score >=10% and patient age 60-69 (Grade C):
Recommendation: Consider aspirin 81mg po daily if patient is NOT at high risk for bleeding
Rationale: CVD risk score >10% and age 60-69 without evidence of exclusions

Intervention

DISPLAY link to shared decision making resource (e.g. Mayo Clinic Shared Decision Making National Resource Center).

Intervention

DISPLAY link to USPSTF guidelines.

Intervention DISPLAY link to education materials that are relevant to the patient's plan of care
Action REQUEST medication order
Action DOCUMENT any new medications on the active medication list
Action DOCUMENT provider response if a reason for not prescribing aspirin is provided
Testing Experience
Pilot Experience

This artifact is in draft status and has not been tested in a clinical setting.