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Abstract EP37: Single Dose Aspirin At The First Sign Chest Pain: Reducing Myocardial Infarction Deaths For Us Adults


 Introduction:
 Acute myocardial infarction (AMI) is a leading cause of morbidity, mortality, and healthcare costs in the United States (US). Aspirin is an effective, low-cost pharmaceutical that can significantly reduce mortality after AMI. The extent of self-administration of aspirin by individuals at the onset of an AMI is undocumented and must be assumed to be the rare exception. Even among adults admitted to an emergency room, only half receive aspirin within a few hours.
 
 
 Objective:
 The objective of this study was to evaluate the benefits and potential harms of adults self-administering a single dose of aspirin at the onset of chest pain in the US, including deaths delayed from AMI, deaths due to excessive bleeding, and costs per year of life saved (YOLS).
 
 
 Methods:
 Estimates of AMI incidence rate from the Global Burden of Disease study and population data from the US Census Bureau were used to derive a study cohort of adults over the age of 40 in the US in 2019. We conducted a systematic review to quantify the positive predictive value of a non-specific chest pain for AMI. A 25% relative risk reduction of mortality, based on the Second International Study of Infarct Survival (ISIS) Trial, was applied to case fatality rates of MI derived from a prior global review study. The main outcome was net deaths delayed from aspirin, calculated from deaths delayed post AMI accounting for deaths from excessive bleeding. Secondary outcomes included YOLS and cost of aspirin/YOLS, calculated summing the YOLS and dividing by total cost of aspirin for all adults experiencing chest pain. All analyses were stratified in 5-year age-sex groups.
 
 
 Results:
 Assuming all adults over the age of 40 years in the US took aspirin within 2 hours of chest pain onset, the total net deaths delayed in 2019 was estimated to be 81,810. There was a total of 83,226 deaths delayed post AMI, which was offset by 1,417 aspirin-related deaths from excess bleeding, leading to an estimated 869,727 YOLS. The cost of the pills was $423,066, translating to $0.49 per YOLS. Benefits were greatest among males and older adults between ages 65 to 75 years.
 
 
 Conclusions:
 For less than fifty cents per year of life saved, aspirin has the potential to save over 80,000 lives in the US. Benefits of reducing deaths post AMI outweighed the risk of bleeding from aspirin. As aspirin is cost-effective and easily-accessed, efforts should be made to promote ready access and timely use of aspirin within the first 2 hours of chest pain to reduce mortality associated with AMI in the US and abroad.
