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

描述(由申请人提供)：提出了一个示范和实施项目，旨在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重大进展，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的积极结果的背景下，越来越多的人一致认为，如果适当使用阿司匹林，可以降低45-79岁的男性和55-79岁的女性的心血管发病率。美国预防服务工作组在2009年的报告中建议使用阿司匹林作为一级预防，最近在CDC/CMS的百万心脏ABCs(阿司匹林、血压、胆固醇、吸烟)运动中建议使用阿司匹林。阿司匹林的使用也被推荐在2020年健康人目标中。然而，许多受益的成年人没有服用阿司匹林。我们很幸运地收到了一大笔慈善捐款，以发起一项运动，在明尼苏达州增加阿司匹林的适当使用。拟议的赠款要求提供资金，以评估这项运动及其提出的创新方法。在创新的大众媒体努力的背景下，我们打算测试卫生系统改革的新方法，以增加适当的阿司匹林使用。使用双臂设计，我们在该州定义了24个地理区域，这些区域将形成小组随机试验的基础。这一设计将使我们能够区分干预方法的效果。这些干预措施将通过在基线和后续行动时对目标年龄一般人口进行顺序调查来评估。在该人群中适当使用阿司匹林将是主要目标和终点。对邻近的中西部上州(爱荷华州、北达科他州和南达科他州、威斯康星州)的同步调查将评估长期趋势。发病率和死亡率数据将监测与使用阿司匹林相关的疾病趋势和并发症。在明尼苏达州北部的一个中型社区进行的一项实质性的先导性研究使我们能够在社区层面改进和验证我们的干预和测量方法。这一试点还展示了支持我们的设计假设的巨大行为变化。这一计划，如果成功，应该会产生一个在现实世界人口环境中测试的可推广的计划。

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.