Should She Keep Taking Her Daily Aspirin? An Evidence-Based Decision for a 72-Year-Old Woman Without Cardiovascular Disease
[Student Name]
University of Phoenix
NSG/506: Transition to Advanced Practice Nursing
Week 5 Assignment
[Instructor Name]
[Date]
The patient and practice are a composite written for a model paper. No real patient is described.
At a routine visit, a composite 72-year-old retired bookkeeper asked her nurse practitioner a question she had been wondering about for months: a friend told her she should stop taking aspirin, and her pharmacist said the same, but she had started it ten years ago on a doctor's advice to prevent a heart attack. She has never had a heart attack, stroke or other cardiovascular event. She was not asking for a lecture on guidelines; she was asking whether the pill she had trusted for a decade was helping her or hurting her. This paper walks through the evidence-based decision that answered her question.
Evidence-Based Practice as a Process
Sackett et al. (1996) defined evidence-based medicine as the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients, integrating individual clinical expertise with the best available external evidence. Nursing models describe the same integration and add a step-by-step process: cultivating a spirit of inquiry, asking a clinical question in PICO format, searching for the best evidence, appraising it, integrating it with clinical expertise and patient preferences, evaluating the outcome and disseminating the results (Melnyk & Fineout-Overholt, 2023). This paper follows that sequence.
The Question
In adults aged 70 or older without cardiovascular disease (P), does continuing daily low-dose aspirin (I), compared with stopping it (C), reduce cardiovascular events without increasing major bleeding (O)?
The patient's details sharpen the question. She has treated hypertension and hyperlipidemia on a statin, does not smoke, has no diabetes and had a peptic ulcer at age 60 that was treated for Helicobacter pylori. Her estimated kidney function is mildly reduced.
The Evidence
A search for high-level evidence found a large randomized trial and a current national recommendation.
The ASPREE trial randomized 19,114 community-dwelling older adults without cardiovascular disease, dementia or disability, most aged 70 or older, to 100 mg of aspirin daily or placebo (McNeil et al., 2018). Over a median of 4.7 years, aspirin did not significantly reduce the risk of cardiovascular disease, but it significantly increased the risk of major hemorrhage, most of it gastrointestinal bleeding and intracranial bleeding.
After a systematic review that included ASPREE, the national preventive services task force recommends against initiating low-dose aspirin for the primary prevention of cardiovascular disease in adults aged 60 or older, concluding with moderate certainty that there is no net benefit. For adults aged 40 to 59 with an estimated 10-year cardiovascular risk of 10% or more, the decision should be individual (US Preventive Services Task Force, 2022). The Task Force also notes that for people already taking aspirin, stopping around age 75 may be reasonable, with the decision based on individual circumstances.
Appraisal
The trial is strong evidence. It was large, randomized, double-blind and placebo-controlled, and its population, healthy older adults, closely matches this patient. Its main limitation for her decision is that it tested starting aspirin, not stopping it after years of use; there is less direct evidence about discontinuation. The median follow-up of under five years also means that very long-term effects are uncertain.
The Task Force recommendation is high-quality synthesized evidence, based on a systematic review and explicit methods for weighing benefit and harm. Its wording about continuation is more cautious than its wording about initiation, reflecting the gap in trial evidence on stopping.
Applied to this patient, the evidence points in one direction. She has no cardiovascular disease, so aspirin would be primary prevention. At 72, she is in the age group in which the trial found no cardiovascular benefit and a clear increase in bleeding. Her prior peptic ulcer increases her personal risk of gastrointestinal bleeding beyond the trial average. Her cardiovascular risk is already addressed by blood pressure control and a statin.
Clinical Expertise and Patient Values
Evidence does not make the decision alone. The nurse practitioner's clinical judgment added two points. First, the patient's ulcer history made the bleeding risk more than theoretical. Second, stopping aspirin in someone with no vascular disease or stents carries little risk, so there was no reason to taper or delay.
The patient's values were explored directly. She said she had kept taking the aspirin because she believed it protected her heart and because stopping felt like "giving up" on prevention. When the nurse practitioner explained the trial's results in plain numbers, that among people like her aspirin did not reduce heart attacks and strokes over about five years but did increase serious bleeding, she said the risk of a bleeding stomach frightened her more than the small, uncertain benefit. She also valued that her statin and blood pressure medicine were doing the preventive work.
Presenting the Numbers Honestly
How the evidence was explained mattered as much as the evidence itself. Relative figures, such as a percentage increase in bleeding, can sound alarming or trivial depending on how they are framed. The nurse practitioner instead used absolute numbers from the trial, expressed as events per 1,000 people over about five years, and drew them as two rows of small figures on a sheet of paper: one row showing that heart attacks and strokes occurred at about the same rate with or without aspirin, and another showing more serious bleeding in the aspirin group. She checked understanding with teach-back, asking the patient to explain in her own words what the drawing showed. Presenting benefits and harms in the same units, over the same time period, lets a patient weigh them fairly; presenting only one of them, or each in a different form, quietly makes the decision for her.
The Decision
Together they decided that she would stop aspirin. The nurse practitioner documented the rationale, including the trial, the recommendation, her ulcer history and her preference, updated the medication list and asked her to tell the pharmacist and any specialists. She was reminded that aspirin should be restarted only if she developed a cardiovascular condition for which it is indicated, such as a heart attack or stroke, and that sudden chest pain or stroke symptoms require emergency care regardless.
Evaluation and Dissemination
At a follow-up visit three months later, she had stopped aspirin, reported no problems and said she felt reassured by understanding the reason. The nurse practitioner then asked a broader question: how many other older patients in the practice were taking aspirin for primary prevention without a documented reason? A search of the electronic record found 214 patients aged 70 or older with aspirin on their medication lists and no recorded cardiovascular disease. She presented the evidence at a practice meeting, and the team agreed to review aspirin use at annual wellness visits for these patients, using a brief shared decision script. An individual decision became a practice change.
Conclusion
An evidence-based decision about a single daily pill required every step of the process: a focused question, a search for the strongest evidence, appraisal of how well a trial and a guideline fit this patient, the clinician's judgment about her ulcer history and the patient's own values. The decision to stop aspirin was grounded in evidence, shaped by her circumstances and made with her. Extending the question to the whole practice shows how evidence-based decisions in advanced practice can move from one patient to many.
References
McNeil, J. J., Wolfe, R., Woods, R. L., Tonkin, A. M., Donnan, G. A., Nelson, M. R., Reid, C. M., Lockery, J. E., Kirpach, B., Storey, E., Shah, R. C., Williamson, J. D., Margolis, K. L., Ernst, M. E., Abhayaratna, W. P., Stocks, N., Fitzgerald, S. M., Orchard, S. G., Trevaks, R. E., ... Murray, A. M. (2018). Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. New England Journal of Medicine, 379(16), 1509-1518. https://doi.org/10.1056/NEJMoa1805819
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn't. BMJ, 312(7023), 71-72. https://doi.org/10.1136/bmj.312.7023.71
US Preventive Services Task Force. (2022). Aspirin use to prevent cardiovascular disease: US Preventive Services Task Force recommendation statement. JAMA, 327(16), 1577-1584. https://doi.org/10.1001/jama.2022.4983
How this NSG 506 Week 5 example is structured
The University of Phoenix library guide for NSG/506 lists Week 5 as Evidence-Based Decision-Making. The paper uses one common clinical decision so each step of evidence-based practice can be shown rather than described: forming a question, finding the best evidence, appraising it, integrating clinical expertise and patient values, deciding and evaluating. The appraisal section weighs a trial against a guideline and asks whether the evidence fits this patient, which is where graduate-level reasoning shows. Students search this week as NSG 506 Week 5, NSG506 Wk 5 or NSG/506 Wk 5; all three are the same assignment.
NSG/506 Week 5 questions, answered
What does NSG/506 Week 5 usually ask for?
The University of Phoenix library guide for NSG/506 lists Week 5 as evidence-based decision-making. Many sections ask for a paper that applies the steps of evidence-based practice to a clinical question in the writer's advanced practice role, with appraisal of the evidence and attention to patient preferences. Check your instructions for a required model or format.
Does evidence-based practice mean following the guideline?
Not by itself. Evidence-based practice integrates the best available evidence with clinical expertise and the patient's values and circumstances. A guideline summarizes evidence, but the clinician still has to judge whether it fits the patient and what the patient wants.
What is a PICO question?
A structured clinical question that names the Patient or population, the Intervention, the Comparison and the Outcome. It turns a vague question into one that can be searched and answered.
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