Developing a foundation for a novel emergency department-based intervention to address inappropriate aspirin

PROJECT SUMMARY/ ABSTRACT
Aspirin is one of the most used drugs in the world. Unfortunately, many older adults will consume aspirin
without an established indication, a scenario in which risks (i.e., bleeding) likely outweigh benefits (i.e., primary
stroke/myocardial infarction prevention). Furthermore, many patients use aspirin in the presence of drug-drug
interactions that increase bleeding risk and in the presence of relative contraindications (i.e., history of
recurrent falls). Deprescribing - the purposeful discontinuation or dose reduction of potentially inappropriate
drugs – of chronic aspirin use should be considered after the manifestation of a bleeding event resulting in an
emergency department (ED) visit. Yet, little is known if older adults on chronic aspirin will discuss the possibility
of deprescribing with their primary provider/aspirin prescriber after an ED bleeding event. The objective of this
proposal is to conduct foundational research, guided by Intervention Mapping Theory (IMT), to inform the
development of a novel ED-based deprescribing intervention to address aspirin use among older adults with
bleeding. Aim 1 is to determine the frequency with which older adults receive counseling on the benefits and
risks of chronic aspirin use 14 days after a bleeding event requiring ED care. Aim 2a is to identify patient and
provider factors associated with absence of counseling on the benefits/risks of aspirin within 14 days of an ED
visit for bleeding. Aim 2b is to conduct qualitative interviews to understand the patients’ perspective on the
decision-making process in continuing (or discontinuing) aspirin use after a bleeding event. In applying IMT, we
will demonstrate the need and theoretical framework for a paradigm shifting ED-based intervention to facilitate
supervised deprescribing of aspirin after an ED encounter for bleeding. This study will be led by an ED
physician (Martin Casey MD MPH) who seeks to build a career in leveraging the ED to promote deprescribing
and medication optimization in older adults. His work will be completed under the guidance of a diverse
mentorship team with expertise in aging epidemiology (Michelle Meyer PhD), geriatric cardiology (Parag Goyal
MD MSc), geriatrics and deprescribing (Jan Busby-Whitehead MD), and geriatric ED care processes (Ula
Hwang MD). In completing this work with his mentorship team, Dr. Casey will move towards becoming a
pioneering emergency medicine physician with expertise in deprescribing.

Grant Number: 1R03AG089044-01
NIH Institute/Center: NIH
Principal Investigator: Martin Casey