Category: Professional Posters
Purpose: Cardiovascular diseases (CVD) are considered the leading cause of morbidity and mortality worldwide. Long term aspirin use has shown significant reductions in major occlusive events including coronary heart diseases. In secondary prevention, the benefits outweigh bleeding risks. However, its use in primary prevention is still controversial among physicians due to different risk assessment methods. Due to insufficient data on aspirin use for primary and secondary prevention of CVD in Lebanon, we conducted this study to evaluate the knowledge, attitudes, and current practices of Lebanese physicians in relation to the use of aspirin.
Methods: A cross-sectional observational study was conducted in Lebanon from January to April 2019. The institutional review board of participating hospitals and of the school of pharmacy at the Lebanese International University approved the study. Recruited participants were attending physicians and residents practicing in any unit of seven hospitals and external clinics. After receiving an oral informed consent, participants filled a pre-established questionnaire. Demographic information was gathered. Knowledge was assessed based on the latest recommendations for the use of aspirin for primary and secondary prevention of CVD. Attitudes were evaluated with regards to the prescribed dose and dosage form of aspirin, while prescribing practices were determined using questions collecting information about patient education when prescribing aspirin and medications co-prescribing habits. In addition, we computed a continuous score to evaluate the level of physician’s knowledge. Statistical analysis was performed using SPSS version 21.0. Descriptive analyses were reported as mean standard deviation (SD) for quantitative variables or frequency and percentage for categorical variables. Bivariate and multi-variable analysis to determine factors associated with knowledge score were assessed using student t-test, one-way ANOVA and Kruskal-Wallis, as well as linear regression models. A p-value≤0.05 was deemed statistically significant.
Results: A total of 230 Lebanese physicians and residents were included. The mean age ± SD was 43.41±13.77 years and 165 (71.7%) were males. Physicians reported prescribing aspirin for secondary prevention in the following indications: myocardial infarction (99.1%), coronary artery bypass graft (97.4%), percutaneous coronary intervention (PCI) with stent placement (98.3%), stroke (93.9%), transient ischemic attack (83.4%), stroke prophylaxis in atrial fibrillation (42.2%), and PCI without stent (36.1%). On the other hand, in patients having additional diagnosis, physicians reported prescribing aspirin as such: cardiac failure (28.3%), hiatus hernia (25.7%), asthma (11.8%), or potential bleeding disorder (6.5%). For primary prevention, the prophylactic use of aspirin was reported in patients with risk factors of CVD: age>65 years (85.7%), diabetes (76.5%), or family history of CV events (79.2-86.6%). For other risk factors, the majority of the physicians were confused whether to prescribe aspirin or not (23-56.5%). Most Lebanese physicians shared a common attitude towards aspirin formulation and dose: enteric coated (98.2%) and 81mg (97.9%) as well as concordant practice and medications co-prescription. Bivariate analysis showed significant differences in physicians’ knowledge, most knowledgeable being older (p<0.001), attending physicians compared to residents (p<0.001) and with more years of experience (p<0.001).
Conclusion: This study showed that aspirin was appropriately prescribed by Lebanese physicians for secondary prevention of CVD. However, the majority of physicians either tend to prescribe aspirin despite its questionable benefits or were confused about aspirin use for primary prevention in patients with CV risk factors. Moreover, prophylactic use of aspirin was reported higher in Lebanon compared to US and Europe. Therefore, further educational interventions and appropriate dissemination of updated guidelines is required to reduce uncertainty and improve the quality of CVD preventive care in Lebanon.