Aspirin underutilized as pre-hospital care for heart attack patients


As many as half of patients who have a heart attack in the United States may not be receiving a recommended, potentially life-saving dose of aspirin on the way to the hospital, according to a study published online February 12, 2015, by the Emergency Medicine Journal.

Early use of aspirin can reduce deaths from acute coronary syndrome by 23 percent. Established guidelines from the American Heart Association, the American College of Cardiology, the Centers for Medicare and Medicaid Services, and the Joint Commission on Accreditation of Health Care Services, all recommend giving aspirin to heart attack patients as soon as possible.

But this study, using data from 2011, reinforced previous smaller studies showing that emergency medical service (EMS) providers may often omit this vital step.

“We wanted to find out how often patients with symptoms suggestive of a heart attack were given aspirin by EMS providers,” said the study’s lead author, emergency medicine physician and EMS Medical Director Katie Tataris, MD, assistant professor of medicine at the University of Chicago.

Katie Tatris, MD

She and colleagues—Mary Mercer and Prasanthi Govindarajan from the University of California at San Francisco—reviewed data from the 2011 National EMS Information System (NEMSIS) database, which includes data on ambulance transport from contributing EMS agencies in 35 states and territories.

They narrowed down more than 14 million EMS incidents in the 2011 data base to focus on the 198,231 ambulance runs involving people age 40 or older who reported chest pain to paramedics and had an electronic cardiogram or heart rate monitoring in the ambulance. Those with chest pain related to injuries were excluded.

They found that paramedics recorded giving aspirin to 90,005 people or 45.4 percent of transported patients having a suspected heart attack. There was no documentation of aspirin administration in the database for the other 108,226 people, 54.6 percent, received aspirin on their way to the hospital.

They found broad regional and racial variations in the results. Patients from the East were most likely to receive aspirin (51%), followed by those from the West (48%), North Central (41%) and South Central (37%) regions.

They also found racial differences. Asian patients were the most likely (57%) to receive aspirin, followed by Hispanics (56%) and non-Hispanic black patients (51%). White patients (43%) were the least likely to receive aspirin from the EMS provider.

Neither age nor gender seemed to affect whether a patient received aspirin.

The regional and ethnic variations, however, were less significant than the large number of patients who did not receive early aspirin. “Few treatments in medicine have been shown to be as effective as aspirin in decreasing mortality from acute coronary syndrome,” the authors note. “It is important that aspirin be administered quickly by EMS if the patient has not already taken it.”

The researchers emphasize that their results are based on documentation by paramedics. The records do not explain why paramedics did not provide aspirin to these patients. Some may have been taking a daily aspirin for an existing health issue. A 2005 study found that as many as 20 percent of US adults reported taking an aspirin at least every other day. Other patients may have been unable to take aspirin for medical reasons, or they may have taken an aspirin before paramedics arrived.

The American Heart Association and others recommend that people with symptoms of a heart attack should quickly call 9-1-1. During that call, they should ask the responder about taking an aspirin. If recommended, they should take one uncoated adult-strength aspirin, which can help keep a clogged artery partially open. Prior studies indicate that chewing it will get it into the bloodstream quicker.

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