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Current Research: Cardiology

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Antiplatelet and anticoagulant nonuse for acute myocardial infarction in the emergency department: An analysis from the National Hospital Ambulatory Medical Care Survey, 2002-2010

Author(s): Ankur Sethi*, Rohit R Arora and Sandeep Khosla

Background: Recent reports from quality improvement registries revealed high antiplatelet and anticoagulant use within 24 h of hospitalization for acute myocardial infarction (AMI).

Objective: To produce an unbiased national estimate of the use of antiplatelets and anticoagulants during visits to the emergency department (ED) for AMI.

Methods: Data from the National Hospital Ambulatory Medical Care Survey for AMI visits from 2002 to 2010 were analyzed. The complex survey design was taken into consideration to ensure that reliable national estimates were produced.

Results: During the study period, there were 3,825,905±308,534 estimated eligible ED visits for AMI. Acetylsalicylic acid was not used in 55.5±2.9%, 55.7±4.0% and 55.2±4.8% of visits in 2002 to 2004, 2005 to 2007 and 2008 to 2010, respectively (Ptrend=0.96). The nonuse of thienopyridine or glycoprotein IIb/IIIa inhibitors (GPI) decreased during this period (92.9±1.4%, 88.1±2.6% and 83.4±3.4%, respectively; Ptrend=0.001). Anticoagulant nonuse did not change (72.1±2.6%, 68.0±3.7% and 65.5±4.4%, respectively; Ptrend=0.14). Even in definitive AMI visits, nonuse was high (acetylsalicylic acid, 48.7±4.5%, 44.7±6.2% and 55.6±5.6%, respectively, Ptrend=0.31; thienopyridine/GPI, 81.9%±3.4%, 77.0±5.0% and 71.1±5.5%, respectively, Ptrend=0.001; and anticoagulants, 49.3±9.6%, 47.1±7.1% and 45.3±6.20%, respectively, Ptrend=0.24). ED visits in a metropolitan statistical area were more likely to receive acetylsalicylic acid (OR 2.27 [95% CI 1.02 to 5.09]) and anticoagulants (OR 3.34 [95% CI 1.54 to 7.24]). Similarly, visits evaluated by a consulting physician were more likely to receive thienopyridine/GPI (OR 2.24 [95% CI 1.22 to 4.13]) and anticoagulants (OR 1.73 [95% CI 1.14 to 2.63]).

Conclusion: In a significant proportion of AMI visits, including definitive AMI, antiplatelet and anticoagulant therapies were not administered in the ED.

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Current Research: Cardiology