Aspirin not given to many heart-attack patients, despite recommendation

A new study shows that only 45 percent of 463 emergency-room heart-attack patients received a timely dose of aspirin at the hospital. Medical guidelines call for immediate administration of 160 mg of aspirin to patients suspected of having had a heart attack.

PROVIDENCE, R.I. -- Use of aspirin by doctors to treat heart attacks is on the rise, but a new study indicates that as late as 1994, physicians delivered the drug late or not at all to many emergency room patients eventually diagnosed as having suffered heart attacks.

The study indicates that physicians need both a better sense of the ways in which heart attacks are presented in patients and an improved understanding that aspirin therapy can abort or limit those heart attacks, said Alfred F. Parisi, M.D., senior author. Parisi is chief of cardiology at Miriam Hospital and a professor of medicine in the Brown University School of Medicine, both in Providence, RI.

Because the American Heart Association and the American College of Cardiology recommend that aspirin therapy begin as soon as possible after a heart attack, Parisi urges physicians to administer the drug at once in all confirmed or suspected heart-attack cases. Besides the proven benefits of reducing heart-attack fatalities, aspirin treatment is cost-effective, easy to administer and can be halted immediately if acute coronary disease is not diagnosed, he said.

The study by Brown University faculty was published in the July 1997 issue of the journal Annals of Internal Medicine. The researchers found that the recommended dose of aspirin (160 mg) was not given to 55 percent (253 out of 463) of emergency room patients who were hospitalized and diagnosed with acute myocardial infarction, otherwise known as a heart attack. Seventy-eight percent of patients who were given aspirin received it more than 30 minutes after arrival in emergency rooms. This, despite treatment guidelines that aspirin is safe, effective and should be administered immediately at the first sign of a heart attack.

The study was a retrospective review of records of patients brought into emergency departments in four Rhode Island hospitals in 1994. The patients were admitted to the hospitals for evaluation and treatment of suspected acute myocardial infarction. All four hospitals are affiliated with Brown University.

"We realize this is 1994 data and that three years down the line physician awareness of aspirin treatment has heightened," said Parisi. "In fact, subsequent surveys seem to indicate that aspirin use as a heart attack treatment has gone up. But for some physicians, aspirin is a simple, effective therapy that has become overshadowed by new higher-tech methods used to treat heart attacks."

In the Brown study, 17 percent of patients who presented symptoms of unstable angina or congestive heart failure when first examined were later diagnosed at time of discharge as having suffered heart attacks, a finding that suggests many heart-attack patients were deprived of the benefits of early aspirin therapy. The study authors urge the medical community to reject rigid treatment approaches that restrict aspirin use only to those patients with the strongest evidence of a heart attack.

Among other findings in the study, doctors were more likely to prescribe aspirin to younger patients, men, smokers and patients with a family history of heart disease. Indeed, many factors were associated with less frequent use of aspirin. For example, among patients already receiving long-term aspirin therapy, 23 percent received the drug in the emergency room compared with 33 percent of patients not previously under an aspirin treatment. Likewise, 17 percent of patients receiving long-term treatment with warfarin, an anti-coagulant, were given aspirin compared with 31 percent of patients not receiving warfarin therapy.

The benefits of aspirin therapy for heart attacks were first described in an international study of 17,000 patients published in 1988. That study showed that aspirin treatment reduced mortality rates by 23 percent and cut the incidence of non-fatal heart attacks by 49 percent. Medical guidelines published in 1994 recommended immediate administration of 160 mg of aspirin to patients who were suspected of having suffered a heart attack.

Parisi said the Brown researchers want to survey the Providence-based emergency departments again to compare the current use of aspirin therapy with 1994 figures.