Self-administered aspirin immediately after myocardial infarction saves lives, study finds
Taking aspirin within four hours of severe chest pain onset and continuing treatment for 28 days after an acute myocardial infarction delayed 13,016 deaths annually, even after accounting for 963 deaths due to bleeding, researchers estimated.
Self-administration of aspirin within four hours of severe chest pain onset has the potential to save 13,000 lives a year in the U.S., a study found.
Researchers sought to quantify the mortality benefit of self-administering 325 mg of aspirin at the onset of chest pain and continuing treatment for 28 days after an acute myocardial infarction (AMI), regardless of need for emergent surgical procedures. A population simulation model was used to determine the impact.
ICD-10 codes and one-year case fatality rates of ischemic heart disease from the U.S. and Canada were used to determine AMI cases. To estimate the number of patients who experienced AMI and severe chest pain, they multiplied the age- and sex-specific incidence of AMI with sex-specific sensitivity of severe chest pain from a meta-analysis of 13 studies. They also estimated the years of life saved (YOLS), costs, and cost per YOLS. Results were published May 1 by the Journal of the American Heart Association.
Taking aspirin within four hours of severe chest pain onset delayed 13,016 (95% CI, 11,643 to 14,574) deaths annually, after accounting for deaths due to bleeding (963; 95% CI, 926 to 1,003). This translated to an estimated 166,309 YOLS (95% CI, 14,9391 to 185,505 YOLS) at a cost of $643,235 (95% CI, $633,944 to $653,010) per year, leading to a cost-effectiveness ratio of $3.70 (95% CI, $3.32 to $4.12) per YOLS. The researchers noted that the benefits of reducing deaths from AMI outweighed the risk of bleeding deaths from aspirin 10 times over.
"Self-administration of aspirin would have immediate population-level effects on AMI mortality," the authors concluded. Other effective secondary prevention strategies such as statins rely on longer-term daily adherence and maintained changes and depend on income, education, and other sociodemographic factors. "While efforts should continue to scale up access to other pharmaceutical therapies such as statins, as well as encourage dietary improvements, self-administration of aspirin alone can drastically reduce AMI mortality without imposing financial strains or requiring long-term behavioral change," the authors concluded.