Testing a Community Intervention to Increase Aspirin Use for Primary Prevention of Cardiovascular Disease

测试社区干预措施以增加阿司匹林的使用，以预防心血管疾病

• 批准号: 9187044
• 负责人: Russell V Luepker
• 金额: $ 71.33万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-12-01 至 2019-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9187044
• 关键词: Acute myocardial infarction; Adult; Adverse event; Advisory Committees; Age; Area; Aspirin; Attention; Blood Pressure; Brain hemorrhage; Cardiovascular Diseases; Cardiovascular system; Centers for Disease Control and Prevention (U.S.); Cessation of life; Cholesterol; Communities; Community Health; Consensus; Controlled Study; Cost Analysis; Data; Detection; Disease; Dose; Effectiveness; Effectiveness of Interventions; Event; Funding; Gastrointestinal Hemorrhage; General Population; Geographic Locations; Geography; Goals; Grant; Health; Health system; Healthy People 2020; Heart; Individual; Intervention; Iowa; Letters; Mass Media; Measurable; Measurement; Measures; Media Campaign; Media Intervention; Meta-Analysis; Methods; Midwestern United States; Minnesota; Modeling; Monitor; Morbidity - disease rate; Myocardial Infarction; North Dakota; Patient Self-Report; Philanthropic Fund; Physicians; Pilot Projects; Population; Prevention; Prevention approach; Prevention program; Preventive service; Primary Prevention; Public Health; Publishing; Randomized; Randomized Clinical Trials; Recommendation; Relative Risks; Reporting; Research Design; Research Personnel; Risk Reduction; Sampling; Smoking; South Dakota; Stroke; Surveys; Testing; United States; Wisconsin; Woman; Women' s Health; aged; arm; base; behavior change; cardiovascular disorder prevention; cardiovascular disorder risk; cholesterol control; cigarette smoking; community intervention; cost; design; disability; disorder prevention; experience; follow-up; high risk; hospital admission rate; hypertension control; improved; innovation; intervention effect; intervention program; men; middle age; mortality; population based; prevent; programs; public health relevance; randomized trial; therapy design; trend

DESCRIPTION (provided by applicant): Proposed is a demonstration and implementation project to increase the appropriate use of aspirin for primary prevention of acute myocardial infarction and stroke in the population of Minnesota. Although significant progress in the reduction of acute myocardial infarction and stroke is apparent, these cardiovascular disorders continue as the leading causes of morbidity and mortality. In recent years, and in the context of the positive results from large randomized clinical trials, there is growing consensus that aspirin when appropriately used, reduces cardiovascular morbidity in men aged 45-79 and women aged 55-79 years. The use of aspirin for primary prevention was recommended in the U.S. Preventive Services Task Force Report in 2009 and more recently in the CDC/CMS 'Million Hearts' ABCs (aspirin, blood pressure, cholesterol, smoking) campaign. Aspirin use is also recommended in the Healthy People 2020 goals. However, many adults who would benefit are not taking aspirin. We have been fortunate to receive a large philanthropic donation to launch a campaign to increase appropriate aspirin use in the State of Minnesota. The proposed grant requests funding to evaluate that campaign and the innovative approaches it proposes. In the context of an innovative mass media effort, we intend to test new methods for health system change to increase appropriate aspirin use. Using a two-arm design, we have defined 24 geographic areas in the state that will form the basis for a group-randomized trial. This design will allow us to distinguish the effects of the intervention methods. The interventions will be evaluated by sequential surveys of the target-age general population at baseline and follow-up. Appropriate aspirin use in that population will be the primary goal and endpoint. Simultaneous surveys of adjacent Upper Midwestern states (Iowa, North and South Dakota, Wisconsin) will assess secular trends. Morbidity and mortality data will monitor disease trends and complications associated with aspirin use. A substantial pilot study in a middle-sized community in Northern Minnesota allows us to refine and validate our intervention and measurement methods at the community level. This pilot also demonstrated behavior change of a magnitude supportive of our design assumptions. This program, if successful, should result in a generalizable program tested in a real world population setting.

描述（由申请人提供）：拟议的是一个示范和实施项目，以增加阿司匹林在明尼苏达州人口中用于急性心肌梗死和中风一级预防的适当使用。尽管在减少急性心肌梗死和中风方面取得了显著进展，但这些心血管疾病仍然是发病率和死亡率的主要原因。近年来，在大型随机临床试验取得积极结果的背景下，越来越多的人认为阿司匹林在适当使用时可以降低45-79岁男性和55-79岁女性的心血管发病率。在2009年的美国预防服务工作组报告和最近的CDC/CMS“百万心脏”abc（阿司匹林、血压、胆固醇、吸烟）运动中，推荐使用阿司匹林进行一级预防。《健康人2020年目标》也建议使用阿司匹林。然而，许多可以从中受益的成年人并没有服用阿司匹林。我们很幸运地收到了一大笔慈善捐款，用于在明尼苏达州开展一项运动，以增加阿司匹林的适当使用。拟议的赠款要求提供资金，以评估该运动及其提出的创新方法。在创新大众媒体努力的背景下，我们打算测试卫生系统变革的新方法，以增加阿司匹林的适当使用。使用双臂设计，我们在该州定义了24个地理区域，这些区域将构成分组随机试验的基础。这种设计将使我们能够区分干预方法的效果。干预措施将通过基线和随访时对目标年龄一般人群的连续调查来评估。在该人群中适当使用阿司匹林将是主要目标和终点。同时对邻近的中西部上游各州（爱荷华州、北达科他州和南达科他州、威斯康星州）进行调查，将评估长期趋势。发病率和死亡率数据将监测与阿司匹林使用相关的疾病趋势和并发症。在明尼苏达州北部的一个中等规模的社区进行了一项实质性的试点研究，使我们能够在社区层面上改进和验证我们的干预和测量方法。这个试验也证明了行为的改变在很大程度上支持了我们的设计假设。这个程序，如果成功的话，应该会产生一个在现实世界人口环境中测试的可推广的程序。