Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-24T04:30:35.907Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
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

References

1.Filate, WA, Johansen, HL, Kennedy, CC, Tu, JV.Regional variations in cardiovascular mortality in Canada. Can J Cardiol 2003; 19(11):1241–8.Google Scholar
2.Second International Study of Infarct Survival (ISIS-2) Collaborative Group. Randomised trial of intravenous steptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction. Lancet 1988;2:349–60.Google Scholar
3.Cairns, JA, Gent, M, Singer, J, Finnie, KJ, Froggatt, GM, Holder, D, et al. Aspirin, sulfinpyrazone, or both in unstable angina. N Engl J Med 1985;313:1369–75.CrossRefGoogle ScholarPubMed
4.Théroux, P, Ouimet, H, McCans, J, Latour, JG, Joly, P, Lévy, G, et al. Aspirin, heparin or both to treat acute unstable angina. N Engl J Med 1988;319:1105–11.CrossRefGoogle ScholarPubMed
5.Lewis, HD, Davis, JW, Archibald, DG, Steinke, WE, Smitherman, TC, Doherty, JE, et al. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina: results of a veterans administration cooperative study. N Engl J Med 1983;309:396–403.CrossRefGoogle ScholarPubMed
6.Ryan, TJ, Antman, EM, Brooks, NH, Califf, RM, Hillis, LD, Hiratzka, LF, et al. 1999 Update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Myocardial Infarction). Circulation 1999;100:1016–30.Google Scholar
7.Braunwald, E, Antman, EM, Beasley, JW, Califf, RM, Cheitlin, MD, Hochman, JS, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Unstable Angina. Circulation 2000;102:1193–209.Google Scholar
8.Braunwald, E, Antman, EM, Beasley, JW, Califf, RM, Cheitlin, MD, Hochman, JS, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-st-segment elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Unstable Angina). 2002. Available at: www.acc.org/clinical/guidelines/unstable/unstable.pdf (accessed 2004 July 2).Google Scholar
9.Saketkhou, BB, Conte, FJ, Noris, M, Tilkemeier, P, Miller, G, Forman, DE, et al. Emergency department use of aspirin in patients with possible acute myocardial infarction. Ann Intern Med 1997;127(2):126–9.CrossRefGoogle ScholarPubMed
10.Krumholz, HM, Radford, MJ, Ellerbeck, EF, Hennen, J, Meehan, TP, Petrillo, M, et al. Aspirin in the treatment of acute myocardial infarction in elderly Medicare beneficiaries. Circulation 1995;92:2841–7.Google Scholar
11.Frilling, B, Schiele, R, Gitt, AK, Zahn, R, Schneider, S, Glunz, HG, et al. Characterization and clinical course of patients not receiving aspirin for acute myocardial infarction: results from the MITRA and MIR studies. Am Heart J 2001;141(2):200–5.Google Scholar
12.Soumerai, SB, McLaughlin, TJ, Gurwitz, JH, Pearson, S, Christiansen, CL, Borbas, C, et al. Timelines and quality of care for elderly patients with acute myocardial infarction under Health Maintenance Organization vs. Fee-for-Service insurance. Arch Intern Med 1999;159:2013–20.CrossRefGoogle Scholar
13.McLaughlin, TJ, Soumerai, SB, Willison, DJ, Gurwitz, JH, Borbas, C, Guadagnoli, E, et al. Adherence to national guidelines for drug treatment of suspected acute myocardial infarction. Arch Intern Med 1996;156;799–805.CrossRefGoogle ScholarPubMed
14.Burt, CW.Summary statistics for acute cardiac ischemia and chest pain visits to United States EDs, 1995–1996. Am J Emerg Med 1999;17:552–9.Google Scholar
15.Patrono, C, Coller, B, Dalen, JE, FitzGerald, GA, Fuster, V, Gent, M, et al. Platelet-active drugs : the relationships among dose, effectiveness, and side effects. Chest 2001;119 (1 Suppl):39S–63S.CrossRefGoogle ScholarPubMed