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 National guidelines recommend giving aspirin to heart attack
patients as soon as possible, but emergency medical service (EMS)
providers sometimes omit this vital step, the authors say.
“We were interested in knowing how often patients that presented
with symptoms suggestive of a heart attack were given aspirin by EMS
providers," said lead author Dr. Katie Tataris, an EMS Medical
Director in Chicago and assistant professor of Emergency Medicine at
the University of Chicago.
Symptoms of a heart attack may include pain or tightness in the
chest, shortness of breath or pain in the upper body.
Tataris and her colleagues write in the journal Emergency Medicine
that people who take aspirin are 23 percent less likely to die from
a heart attack and taking it early on is critical.
The study team reviewed data from the 2011 National EMS Information
System database. They focused on nearly 200,000 people under age 40
who reported chest pain to paramedics. Patients who had an
electronic cardiogram or heart rate monitoring in the ambulance were
included, while those with chest pain related to injuries were not.
Overall, paramedics gave aspirin to about 45 percent of patients.
Black, Asian and Hispanic patients were more likely than white
patients to receive aspirin from the EMS provider. People living in
the South were less likely to get aspirin than those in the East,
West or North.
Patients with government insurance such as Veteran’s healthcare were
the least likely to receive aspirin. However, the same was not true
for those with Medicare or Medicaid. People with insurance through
an employer had the greatest likelihood of receiving aspirin.
Age and sex did not affect the odds of receiving aspirin.
Tataris noted that the study can't tell why paramedics failed to
provide patients with aspirin. For instance, some patients might
already be taking aspirin daily, or they might have a condition that
prevents them from using it. Other patients might be more educated
about the value of aspirin in case of heart attack or stroke, so
some might already have taken aspirin before paramedics arrived.
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The American Heart Association recommends that people with symptoms
of a heart attack should first call 9-1-1 and ask the responder if
they should take aspirin. The responder can help determine if there
is any reason the person should not take aspirin, such as an
allergy.
For most people, however, aspirin is a safe intervention, as only 2
to 3 percent of the general population has an intolerance to it, the
researchers write.
Tataris agrees with this recommendation, saying in an email that
“the administration of aspirin should be discussed between the
patient and their health care providers in an emergency situation.”
Malcolm Woollard, former chair of the College of Paramedics and a
visiting professor at the University of Surrey in England, said that
although “early” aspirin is often recommended, “there is no evidence
that 'early' means 'within minutes' rather than 'within hours.'”
Woollard said the main reason for recommending aspirin before
getting to the hospital is to make sure that it is not forgotten.
He noted, however, that taking aspirin immediately is very helpful
for other heart conditions such as angina.
One way for people to protect themselves is to take control of their
own care, said Woollard, who was not involved in the study. He
advised anyone over the age of 35 to carry aspirin with them and,
“if they develop chest pain over a few minutes that they have never
had before they should take an aspirin and call 911.”
SOURCE: bmj.co/17ZPwtc Emergency Medicine Journal, online February
12, 2015.
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