Abstract
Methods—Ambulance services in England and Wales who had conducted a recent aspirin administration audit were identified through the National Clinical Effectiveness Programme for the Ambulance Service Association. Data were requested from each of these services with a 100% return rate.
Results—Nine services out of a total of 35 had collected appropriate data. The proportion of patients who were given aspirin by a paramedic varied from 11% to 74%. The range of proportions of patients receiving pre-hospital aspirin increased after adding those patients who had already received aspirin from an alternative health provider, to 19% to 78%. It is estimated that at least 15% to 74% of patients who should have been given aspirin by the various ambulance services did not receive it. The proportion of patients for whom aspirin was judged to be inappropriate ranged from 4% to 35%. The reason for these widely varying and generally poor levels of compliance is not known. However, the range of indications and contraindications to the administration of aspirin varied considerably by ambulance service. This also made the comparison of data from different sources difficult.
Conclusions—Aspirin has been shown to be beneficial after a myocardial infarction and for other acute coronary syndromes. However, variances in the proportion of patients with suspected ischaemic heart disease given aspirin in different ambulance services indicates the need for a re-emphasis on the importance of this treatment. A standard protocol for all UK ambulance services should be devised that minimises the number of contraindications to aspirin and otherwise requires its administration to all patients with acute coronary syndromes or suspected myocardial infarction. Regular, standardised audits of compliance should also be conducted and their results widely disseminated.
Full Text
The Full Text of this article is available as a PDF (88.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Adams J., Trent R., Rawles J. Earliest electrocardiographic evidence of myocardial infarction: implications for thrombolytic treatment. The GREAT Group. BMJ. 1993 Aug 14;307(6901):409–413. doi: 10.1136/bmj.307.6901.409. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Allison J. J., Kiefe C. I., Centor R. M., Box J. B., Farmer R. M. Racial differences in the medical treatment of elderly Medicare patients with acute myocardial infarction. J Gen Intern Med. 1996 Dec;11(12):736–743. doi: 10.1007/BF02598987. [DOI] [PubMed] [Google Scholar]
- Barakat K., Wilkinson P., Suliman A., Ranjadayalan K., Timmis A. Acute myocardial infarction in women: contribution of treatment variables to adverse outcome. Am Heart J. 2000 Nov;140(5):740–746. doi: 10.1067/mhj.2000.110089. [DOI] [PubMed] [Google Scholar]
- Cairns J. A., Gent M., Singer J., Finnie K. J., Froggatt G. M., Holder D. A., Jablonsky G., Kostuk W. J., Melendez L. J., Myers M. G. Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. N Engl J Med. 1985 Nov 28;313(22):1369–1375. doi: 10.1056/NEJM198511283132201. [DOI] [PubMed] [Google Scholar]
- Eisenberg M. J., Topal E. J. Prehospital administration of aspirin in patients with unstable angina and acute myocardial infarction. Arch Intern Med. 1996 Jul 22;156(14):1506–1510. [PubMed] [Google Scholar]
- Elwood P. C., Cochrane A. L., Burr M. L., Sweetnam P. M., Williams G., Welsby E., Hughes S. J., Renton R. A randomized controlled trial of acetyl salicylic acid in the secondary prevention of mortality from myocardial infarction. Br Med J. 1974 Mar 9;1(5905):436–440. doi: 10.1136/bmj.1.5905.436. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hedman J., Kaprio J., Poussa T., Nieminen M. M. Prevalence of asthma, aspirin intolerance, nasal polyposis and chronic obstructive pulmonary disease in a population-based study. Int J Epidemiol. 1999 Aug;28(4):717–722. doi: 10.1093/ije/28.4.717. [DOI] [PubMed] [Google Scholar]
- Heidenreich P. A., McClellan M. Trends in treatment and outcomes for acute myocardial infarction: 1975-1995. Am J Med. 2001 Feb 15;110(3):165–174. doi: 10.1016/s0002-9343(00)00712-9. [DOI] [PubMed] [Google Scholar]
- Krumholz H. M., Radford M. J., Ellerbeck E. F., Hennen J., Meehan T. P., Petrillo M., Wang Y., Kresowik T. F., Jencks S. F. Aspirin in the treatment of acute myocardial infarction in elderly Medicare beneficiaries. Patterns of use and outcomes. Circulation. 1995 Nov 15;92(10):2841–2847. doi: 10.1161/01.cir.92.10.2841. [DOI] [PubMed] [Google Scholar]
- Lewis H. D., Jr, Davis J. W., Archibald D. G., Steinke W. E., Smitherman T. C., Doherty J. E., 3rd, Schnaper H. W., LeWinter M. M., Linares E., Pouget J. M. 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 Aug 18;309(7):396–403. doi: 10.1056/NEJM198308183090703. [DOI] [PubMed] [Google Scholar]
- Miyamoto S., Ogawa H., Soejima H., Takazoe K., Kajiwara I., Sakamoto T., Yoshimura M., Kugiyama K., Yasue H. Increased rate of formation of small-sized platelet aggregates in patients with acute coronary syndromes. Jpn Circ J. 2000 Sep;64(9):647–652. doi: 10.1253/jcj.64.647. [DOI] [PubMed] [Google Scholar]
- Schuster S., Koch A., Burczyk U., Schiele R., Wagner S., Zahn R., Glunz H. G., Heinrich F., Stuby K., Berg G. Frühbehandlung des akuten Myokardinfarktes: Umsetzung von Therapierichtlinien in den klinischen Alltag, MITRA-Pilotphase. Z Kardiol. 1997 Apr;86(4):273–283. doi: 10.1007/s003920050059. [DOI] [PubMed] [Google Scholar]
- Weston C. F., Penny W. J., Julian D. G. Guidelines for the early management of patients with myocardial infarction. British Heart Foundation Working Group. BMJ. 1994 Mar 19;308(6931):767–771. doi: 10.1136/bmj.308.6931.767. [DOI] [PMC free article] [PubMed] [Google Scholar]
- de Bruyne M. C., Mosterd A., Hoes A. W., Kors J. A., Kruijssen D. A., van Bemmel J. H., Hofman A., Grobbee D. E. Prevalence, determinants, and misclassification of myocardial infarction in the elderly. Epidemiology. 1997 Sep;8(5):495–500. doi: 10.1097/00001648-199709000-00004. [DOI] [PubMed] [Google Scholar]