By Lilian Anekwe
Exclusive: GPs are shunning NICE guidance and reducing their prescribing of aspirin for primary prevention of cardiovascular disease amid growing doubt over whether its use is justified.
Prescribing of aspirin for patients who do not have established CVD has crashed by 19% in just a year, following a series of studies that failed to find benefits for its use in primary prevention.
The fall in aspirin use came as the British Hypertension Society issued a statement cautioning GPs against routine use of aspirin for primary prevention.
Cardiovascular experts are now calling for the NICE to urgently review its guidance, amid concerns the institute has allowed itself to become irrelevant by responding so slowly to changes in evidence. By contrast, the Scottish Intercollegiate Guidelines Network changed its guidance on diabetes to advise against use of aspirin for primary prevention a full eight months ago.
Figures obtained by Pulse from Cegedim Strategic Data show 48,650 scripts were issued in patients without established cardiovascular disease in April 2009, but just 39,600 in April 2010.
Use of aspirin in patients with heart disease remained stable over the same period, suggesting GPs were responding specifically to the recent spate of primary prevention studies.
The MHRA has already warned GPs against prescribing aspirin outside of its licensed indication for secondary prevention and the Joint British Societies is re-examining use of aspirin in its current guidance review, but NICE continues to drag its feet.
At a primary care meeting in London last week the British Hypertension Society – part of the JBS – insisted GPs should now avoid prescribing aspirin.
‘As advocated by the MHRA, physicians should weigh up the benefits and risks of low-dose aspirin in all individuals. An accurate quantitative assessment of 10-year cardiovascular risk is essential before prescribing aspirin for primary prevention of cardiovascular disease’, the statement advises.
Professor Peter Sever, professor of clinical pharmacology at Imperial College London and a former president of the British Hypertension Society said: ‘It’s hard to find data that would provide a compelling case for use of aspirin.
‘In anyone who uses long-term NSAIDs you should really rule out aspirin. I would consider stopping people who have a history of gastrointestinal upset or are on NSAIDs or have dyspeptic symptoms.’
Professor David Fitzmaurice, professor of primary care research at the University of Birmingham and a GP, said he was pleased to see the decline in aspirin prescriptions.
‘This a good thing. Aspirin prescribing for primary prevention of cardiovascular disease has largely been an article of faith rather than evidence-based.’
GPs shun asprin for primary prevention of CVD