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

Abstract

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. EM ADVANCES • INNOVATIONS EN MU

Beneficial Moral Hazard and the Theory of the Second Best

“…Whatever the reasons, considerable evidence suggests that individuals often fail to use medical services that have been proven effective and to offer large benefits relative to the costs (Cokkinides et al 2003;Dufresne et al 2004;Iba et al 2006;Ibrahim and Kwoh 2000;Krumholz et al 1998;McGlynn et al 2003;Stafford and Radley 2003). This underutilization can occur at any number of points in the process of providing appropriate medical care.…”

Development and validation of a compact on-person storage device (SMHeartCard) for emergency access to acetylsalicylic acid and nitroglycerin

“…6 Development and validation of a compact on-person storage device (SMHeartCard) for emergency access to acetylsalicylic acid and nitroglycerin OPEN Research An audit of a Canadian hospital showed that, among patients presenting with acute coronary syndromes (myocardial infarction or unstable angina), the median time to ASA and nitroglycerin administration was more than 90 minutes after arrival at the emergency department. 7 About 30% of people with myocardial infarction do not survive long enough to reach medical care, 8 and this is more frequent in people who live and work in geographically isolated areas.…”