Self-Administration of Aspirin After Chest Pain for the Prevention of Premature Cardiovascular Mortality in the United States: A Population-Based Analysis.

Autor: Russo RG; Department of Epidemiology Harvard T.H. Chan School of Public Health Harvard University Boston MA., Wikler D; Department of Global Health and Population Harvard T.H. Chan School of Public Health Harvard University Boston MA., Rahimi K; Nuffield Department of Women's & Reproductive Health Oxford Martin School University of Oxford Oxford UK., Danaei G; Department of Epidemiology Harvard T.H. Chan School of Public Health Harvard University Boston MA.; Department of Global Health and Population Harvard T.H. Chan School of Public Health Harvard University Boston MA.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Jun 04; Vol. 13 (11), pp. e032778. Date of Electronic Publication: 2024 May 01.
DOI: 10.1161/JAHA.123.032778
Abstrakt: Background: Aspirin, an effective, low-cost pharmaceutical, can significantly reduce mortality if used promptly after acute myocardial infarction (AMI). However, many AMI survivors do not receive aspirin within a few hours of symptom onset. Our aim was to quantify the mortality benefit of self-administering aspirin at chest pain onset, considering the increased risk of bleeding and costs associated with widespread use.
Methods and Results: We developed a population simulation model to determine the impact of self-administering 325 mg aspirin within 4 hours of severe chest pain onset. We created a synthetic cohort of adults ≥ 40 years old experiencing severe chest pain using 2019 US population estimates, AMI incidence, and sensitivity/specificity of chest pain for AMI. The number of annual deaths delayed was estimated using evidence from a large, randomized trial. We also estimated the years of life saved (YOLS), costs, and cost per YOLS. Initiating aspirin within 4 hours of severe chest pain onset delayed 13 016 (95% CI, 11 643-14 574) deaths annually, after accounting for deaths due to bleeding (963; 926-1003). This translated to an estimated 166 309 YOLS (149391-185 505) at the cost of $643 235 (633 944-653 010) per year, leading to a cost-effectiveness ratio of $3.70 (3.32-4.12) per YOLS.
Conclusions: For <$4 per YOLS, self-administration of aspirin within 4 hours of severe chest pain onset has the potential to save 13 000 lives per year in the US population. Benefits of reducing deaths post-AMI outweighed the risk of bleeding deaths from aspirin 10 times over.
Databáze: MEDLINE
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