Individual and population benefits of daily aspirin therapy: a proposal for personalizing national guidelines.
Individual and population benefits of daily aspirin therapy: a proposal for personalizing national guidelines.
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DOI：
10.1161/circoutcomes.110.959239
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发表时间：
2011-05
期刊：
影响因子：
--
通讯作者：
Hayward RA
中科院分区：
文献类型：
--
作者：
Sussman JB;Vijan S;Choi H;Hayward RA
临床实践指南，帮助临床医生和患者了解预期的个人风险和利益的大小将有助于以患者为中心的决策和护理的优先级。我们评估了个人每日服用阿司匹林的净效益，以估计更加个性化的决策方法对个人和公共健康的影响。我们使用来自全国健康和营养调查（NHANES）的数据，代表所有年龄在30至85岁之间，没有心肌梗死病史的美国人，并应用基于随机证据和已发表文献的马尔可夫模型来估计阿司匹林治疗的质量调整生命年（Qs）的终身效应。我们表明，治疗的好处有很大的不同，个人的心血管疾病（CVD）的风险。几乎所有的成年人服用阿司匹林后发生的主要临床事件都较少，但对于大多数人来说，预防的事件是如此罕见，以至于即使对阿司匹林使用非常小的厌恶也会使治疗变得不合适。在最小程度上不喜欢使用阿司匹林（负效用= 0.005 QALY/年）的情况下，只有10年心脏事件风险大于6.1%的患者才会有净获益。负效用为0.01 QALY时，该获益分界点移动至10.6%。多种因素改变了阿司匹林的绝对益处，但CVD风险与益处大小之间的密切关系是稳固的。阿司匹林治疗的益处在很大程度上取决于个体的CVD风险和不良治疗作用。了解谁从阿司匹林的使用中受益以及多少可以帮助临床医生和患者制定一种更以患者为中心的预防治疗方法。
Clinical practice guidelines that help clinicians and patients understand the magnitude of expected individual risks and benefits would help patient-centered decision-making and prioritization of care. We assessed the net benefit from daily aspirin in individuals to estimate the individual and public health implications of a more individualized decision-making approach. We use data from the National Health and Nutrition Examination Survey (NHANES) representing all U.S. persons aged 30 to 85 years with no history of myocardial infarction and applied a Markov Model based on randomized evidence and published literature to estimate lifetime effects of aspirin treatment in quality adjusted life years (QALYs). We show that treatment benefit varies greatly by an individual's cardiovascular disease (CVD) risk. Almost all adults have fewer major clinical events on aspirin, but for most, events prevented would be so rare that even a very small distaste for aspirin use would make treatment inappropriate. With minimal dislike of aspirin use (disutility = 0.005 QALY per year), only those with a 10-year cardiac event risk greater than 6.1% would have a net benefit. A disutility of 0.01 QALY moves this benefit cut-point to 10.6%. Multiple factors altered the absolute benefit of aspirin, but the strong relationship between CVD risk and magnitude of benefit was robust. The benefits of aspirin therapy depend substantially on an individual's risk of CVD and adverse treatment effects. Understanding who benefits from aspirin use and how much can help clinicians and patients develop a more patient-centered approach to preventive therapy.