The possibility and incentive for the population to self-administer aspirin within four hours of the onset of severe chest pain, whether a heart attack is subsequently confirmed or not, would save more people each year of 13,000 lives, taking into account the risk of bleeding, at a negligible cost, according to a study published in the Journal of the American Heart Association (JAHA).
Aspirin significantly reduces mortality when initiated quickly after an acute infarction, but most patients do not receive it within hours of symptom onset, partly because less than half of patients having a heart attack access medical care within four hours of the onset of symptoms, but also because the medical regulator often does not recommend giving aspirin to patients with chest pain, the authors point out.
Professional guidelines do not specifically encourage self-administration of aspirin by patients with chest pain, probably due to a lack of specificity of this symptom and fear of aspirin’s side effects, Rienna points out. Russo of the Harvard TH Chan School of Public Health in Boston and colleagues.
They sought to quantify the benefit on mortality of self-administration of aspirin from the onset of symptoms – with the aim of promoting a prevention strategy encouraging the population to have aspirin on hand and to take it. at the onset of severe chest pain, similar to what is done for allergic people with adrenaline to prevent death from anaphylaxis, or for people taking opioids with naloxone to prevent death from overdose.
To do this, they developed a simulation model on the American population, to determine the impact of self-administration of 325 mg of aspirin within four hours of the onset of severe chest pain. They created a synthetic cohort of adults aged 40 and older with severe chest pain, based on the 2019 US population censuses, the incidence of heart attack, and the sensitivity and specificity of chest pain as symptom of heart attack. The death prevention figures were taken from a large randomized trial.
For all adults 40 years and older with severe chest pain, with no heart attack, who self-administered aspirin within four hours of the onset of pain, four outcomes were considered: fatal heart attack, non-heart attack fatal, death related to excessive hemorrhage (gastrointestinal or intracranial), and survival without infarction.
With this strategy, 13,980 deaths from heart attacks would be avoided each year, at the cost of 963 deaths from hemorrhage, or a net benefit of 13,016 deaths avoided. This would translate into 166,309 years of life saved (YOLS- in English), at a cost of $643,235 per year, or a cost-effectiveness ratio of $3.70 per year of life saved.
“Future research should explore best practices to improve awareness of heart attack symptoms and encourage ownership and self-administration of aspirin,” comment the authors.
(JAHA, online publication May 1)
