title: Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database.
abstract: BACKGROUND
  National practice guidelines recommend early aspirin administration to reduce mortality in acute coronary syndrome (ACS). Although timely administration of aspirin has been shown to reduce mortality in ACS by 23%, prior regional Emergency Medical Service (EMS) data have shown inadequate prehospital administration of aspirin in patients with suspected cardiac ischaemia.
  
  
  OBJECTIVE
  Using the National EMS Information System (NEMSIS) database, we sought to determine (1) the proportion of patients with suspected cardiac ischaemia who received aspirin and (2) patient and prehospital characteristics that independently predicted administration of aspirin.
  
  
  METHODS
  Analysis of the 2011 NEMSIS database targeted patients aged ≥40 years with a paramedic primary impression of 'chest pain'. To identify patients with chest pain of suspected cardiac aetiology, we included those for whom an ECG or cardiac monitoring had been performed. Trauma-related chest pain and basic life support transports were excluded. The primary outcome was presence of aspirin administration. Patient (age, sex, race/ethnicity and insurance status) and regional characteristics where the EMS transport occurred were also obtained. Multivariate logistic regression was used to assess the independent association of patient and regional factors with aspirin administration for suspected cardiac ischaemia.
  
  
  RESULTS
  Of the total 14,371,941 EMS incidents in the 2011 database, 198,231 patients met our inclusion criteria (1.3%). Of those, 45.4% received aspirin from the EMS provider. When compared with non-Hispanic white patients, several groups had greater odds of aspirin administration by EMS: non-Hispanic black patients (OR 1.49, 95% CI 1.44 to 1.55), non-Hispanic Asians (OR 1.62, 95% CI 1.21 to 2.18), Hispanics (OR 1.71, 95% CI 1.54 to 1.91) and other non-Hispanics (OR 1.27, 95% CI 1.07 to 1.51). Patients living in the Southern region of the USA (OR 0.59, 95% CI 0.57 to 0.62) and patients with governmental (federally administered such as Veteran's Health Care, but not Medicare or Medicaid) insurance (OR 0.67, 95% CI 0.57 to 0.78) had the lowest odds of receiving aspirin. Age and sex (OR 1.00, 95% CI 1.00 to 1.00) were not associated with aspirin administration.
  
  
  CONCLUSIONS
  It is likely that prehospital aspirin administration for patients with suspected cardiac ischaemia remains low nationally and could be improved. Reasons for disparities among the various groups should be explored.
authors: Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA.
authors: Katie L
authors: KL
authors: Tataris
authors: Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA.
authors: Mary P
authors: MP
authors: Mercer
authors: Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA.
authors: Prasanthi
authors: P
authors: Govindarajan
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011785:Quality Assurance, Health Care; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: ECG; cardiac care, acute coronary syndrome; emergency ambulance systems; paramedics; prehospital care, clinical management