GPs’ decision-making behaviour in the prescription of aspirin for primary prevention in elderly individuals: a qualitative study using semistructured interviews in France

BMC Primary Care Charuel et al. BMC Primary Care (2025) 26:352 https://doi.org/10.1186/s12875-025-03063-x Open Access RESEARCH GPs’ decision-making behaviour in the prescription of aspirin for primary prevention in elderly individuals: a qualitative study using semistructured interviews in France E. Charuel1,2,3, M. Lafanechère1, M. Bigeault1, B. Cambon1,2, S. Bedhomme2,4 and P. Vorilhon1,2,5* Abstract Background Low-dose aspirin has long been recommended for primary prevention. This indication has been reconsidered owing to an unfavourable benefit–risk balance, no proven reduction in cardiovascular risk and an increase in the risk of haemorrhage. The recommendations concerning this indication are still contradictory and are a source of confusion for general practitioners (GPs), especially in the management of patients over 70 years of age who are at greater risk of complications. We explored the determinants of the decision-making behaviour of general practitioners regarding aspirin for primary prevention in patients aged 70 years and older. Methods Grounded theory was the basis of this qualitative study, which involved individual semistructured interviews with GPs in the Auvergia region. The interviews were recorded and analysed by two researchers. Results Twelve GPs were interviewed, and 4 themes were observed. The distinction between primary and secondary prevention was unclear, particularly for patients with diabetes or asymptomatic atheromatous lesions. Cardiovascular risk was assessed using a standardized approach rather than a risk scoring tool. GPs considered physiological age rather than chronological age when assessing the benefits and risks associated with regular low-dose aspirin use. In the end, the opinion of the specialist and that of the patient were paramount in decision-making. Conclusion Our study provides a better understanding of the determinants of GPs’ decision-making in the prescription of aspirin for primary prevention in elderly patients. This occurs in a context of uncertainty and is a source of ambivalence; thus, a clear recommendation would be beneficial. Keywords Aspirin, Primary prevention, Cardiovascular risks, Elderly patients, General practitioner *Correspondence: P. Vorilhon 1 Department of General Medicine, UFR Medicine and Paramedical Professions, Université Clermont Auvergne, 28 Place Henri Dunant, Clermont-Ferrand 63000, France 2 Université Clermont Auvergne, UR ACCePPT, Clermont-Ferrand, France 3 Maison de Santé Pluriprofessionnelle Universitaire des Batignolles (MSPU), Joze 63350, France 4 UFR de Pharmacie, Université Clermont Auvergne, 28 Place Henri Dunant, Clermont-Ferrand 63000, France 5 Clinical Research and Innovation Department, Clermont-Ferrand University Hospital Centre, Clermont-Ferrand F-63000, France © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creati vecommons.org/licenses/by-nc-nd/4.0/. Charuel et al. BMC Primary Care (2025) 26:352 Background Aspirin is recommended for the secondary prevention of atherosclerotic cardiovascular disease (ASCVD) [1]. Low doses of aspirin have long been used for the prevention of cardiovascular disease. However, 3 trials published in 2018 revealed a small reduction in the incidence of cardiovascular events and cardiovascular mortality in patients at high cardiovascular risk (CVR) receiving primary prevention, and this small benefit was offset by an increased risk of haemorrhage [2–4]. Moreover, the ASPREE trial revealed that the risks outweighed the benefits of aspirin as a risk reduction measure for cardiovascular disease in patients over 70 years of age [5]. In addition, according to the European Society of Cardiology, aspirin may be considered for primary prevention in patients with diabetes mellitus with high or very high CVD risk in the absence of clear contraindications; however, the US Preventive Service Task Force does not recommend aspirin in adults 60 years or older [6, 7]. Currently, in France, the only recommendation concerning the use of aspirin as a risk reduction measure dates back to 2012 [8]. Given the contradictory recommendations, it is not always easy for general practitioners (GPs) to adopt the most appropriate clinical practice. Aspirin is still frequently prescribed for primary prevention, especially for elderly patients and patients with diabetes, with rates varying between 10% and 45% depending on the study [9–13]. This relatively high prescription rate is likely Table 1 Interview guide The aim of the first part of this interview is to discuss your practices for prescribing low-dose aspirin for the primary prevention of cardiovascular disease. The questions are open-ended so that you can answer freely and tell me your opinion and practice. - What does primary prevention in the field of cardiovascular disease mean to you? - Can you tell me about the last time you prescribed or combined antiplatelet therapy with aspirin for primary prevention? Please share your specific practice for prescribing aspirin for primary prevention among elderly people (≥ 70 years of age). The second part of this interview focuses on this specific population. - What do you think about prescribing aspirin for primary prevention in elderly individuals (≥ 70 years of age)? - What circumstances or clinical context clinical context prompts the introduction or renewal of aspirin for primary prevention in these patients? - Do you feel that your attitude is supported by clear scientific data? - What factors might limit your prescription? What difficulties or obstacles have you encountered regarding the prescription of lowdose aspirin in the context of primary prevention?The interviews were recorded using a digital recorder dedicated to the study. The interviews were then transcribed verbatim by the investigator using Microsoft Word, and all the data were anonymised. The study data were sent by mail to each of the participants to obtain their approval of the content reported. None of the participants made any changes or added any new data. Pa (...truncated)