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

Objective: Acetylsalicylic acid (AS A) is a simple and cost-effective treatment for acute coronary syndromes (ACS). Our objectives were to determine the frequency of AS A 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 AS A or not in the ED, dosage and form of AS A received, timing of administration, presence of contraindications to AS A and use of regular AS A prior to ED presentation were recorded. Results: Six hundred and one charts were analyzed. Five hundred and fifty patients (91.5%) received AS A. Only 444 (73.9%) of these 550 patients were administered the AS A 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 AS A" and "Gastrointestinal bleed" were associated with a lower probability of the patient being administered AS A. If a patient was noted as taking AS A regularly, it increased the chance of this patient being administered AS A in the ED. Conclusion: Although the study ED performed well, administering AS A to 91.5% of patients with ACS, only 73.9% of the patients who received AS A were administered the AS A 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 AS A therapy.