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Underutilization of acetylsalicylic acid for acute coronary syndromes in the emergency department

Published online by Cambridge University Press:  21 May 2015

François Dufresne ,
Danielle Blouin ,
Xiaoqing Xue  and
Marc Afilalo
François Dufresne*
Affiliation:
Emergency Department, McGill University Health Centre, Montréal, Que
Danielle Blouin
Affiliation:
Department of Emergency Medicine, Queen’s University, Kingston, Ont.
Xiaoqing Xue
Affiliation:
Emergency Medicine Research Department, Jewish General Hospital, McGill University, Montréal, Que.
Marc Afilalo
Affiliation:
Emergency Department, Jewish General Hospital, McGill University, Montréal, Que
*
Emergency Department, Montreal General Hospital, 1650, ave. Cedar, Montréal QC H3G 1A4; 514 934-6011, [email protected]

Abstract

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Objective:

Acetylsalicylic acid (ASA) is a simple and cost-effective treatment for acute coronary syndromes (ACS). Our objectives were to determine the frequency of ASA administration in the emergency department (ED) for patients with acute myocardial infarction or unstable angina, and to identify patient characteristics associated with its administration.

Methods:

This is a retrospective chart review of patients discharged with a final diagnosis of ACS. Data on age, gender, mode of presentation, presence of chest pain at triage, administration of ASA or not in the ED, dosage and form of ASA received, timing of administration, presence of contraindications to ASA and use of regular ASA prior to ED presentation were recorded.

Results:

Six hundred and one charts were analyzed. Five hundred and fifty patients (91.5%) received ASA. Only 444 (73.9%) of these 550 patients were administered the ASA appropriately, according to the American Heart Association / American College of Cardiology (AHA/ACC) guidelines. Univariate analysis showed that chart notes “Transport by ambulance,” “Allergy to ASA” and “Gastrointestinal bleed” were associated with a lower probability of the patient being administered ASA. If a patient was noted as taking ASA regularly, it increased the chance of this patient being administered ASA in the ED.

Conclusion:

Although the study ED performed well, administering ASA to 91.5% of patients with ACS, only 73.9% of the patients who received ASA were administered the ASA appropriately, as recommended in the AHA/ACC guidelines. Educational strategies and system changes are necessary to increase the proportion of eligible ACS patients who receive appropriate ASA therapy.

Keywords

acetylsalicylic acidASAacute coronary syndromesacute myocardial infarctionunstable angina
Type
EM Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 5 , September 2004 , pp. 333 - 336
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

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