" (Jaiwa, 2006, p.1)
Jaiwa reports a more recent study that states findings that out of 52 patients with chest pain only 13 patients or 25% of the 52 received aspirin. The stated reason for not giving aspirin to the other 39 patients included that "chest pain was not felt to be cardiac in thirteen (33%), ten patients (26%) had already taken aspirin on that day, the medical provider was a basic level emergency medical technician who could not administer aspirin to six patients (15%), pain subsided prior to arrival of emergency medical services in three patients." (2006, p.1)
Conclusion of the investigators were that the primary reason that paramedics failed to administer aspirin was "...their belief that the chest pain was not of a cardiac nature while the other common reason being their inability to administer aspirin." (Jaiwa, 2006, p.1) Jaiwa states that billions of individuals throughout the world are taking aspirin as a preventative measure for heart and artery disease. Aspirin has approved the use of aspirin for reduction of risk in the following conditions:
(1) Heart attack in people who have stable angina, predictable chest pain due to impaired blood flow to the heart;
(2) Death in people having heart attack;
(3) Second heart attack in people who have already suffered a heart attack or have unstable angina, chest pain caused by unpredictable impairment of blood flow;
(4) Second stroke in people who have already had one ischemic stroke because of blockage in blood vessel which supplies to brain or those experiencing transient ischemic attack (TIAs). (Jaiwa, 2006, p.1)
Jaiwa states that this situation has improved a great deal however, there are people "dying needlessly because they are not taking the drug when they should." (Jaiwa, 2006, p.1) There have been aspirin foundations formed throughout the world by health care professionals for promoting the use of Aspirin in the indications that have been well-established. The Pakistan Foundation conducted the Aspirin Awareness and Usage Study (AAUS) to examine the knowledge in terms of awareness and the use of Aspirin in Acute Coronary Syndromes presenting for admission at hospitals and coronary care units.
The patterns of aspirin being prescribed as well as other cardiovascular drugs at discharge from hospitals were also examined. Male and female patients of all ages with coronary artery disease as well as unstable angina, acute myocardial infarction "both STEMI and NSTEMI were included." (Jawai, 2006, p.1) Those excluded were individuals with known bleeding disorders, those suffering from peptic ulcer disease and those who were either 36 weeks in gestation and with known G6PD deficiency and those with hypersensitivity to aspirin.
Jawai reports that in all of the 1527 Proformas only 1400 were complete enough for inclusion in the final evaluation as those with incomplete information were excluded. The condition-specific classifications in this study are the following: (1) Six hundred six (43%) patients were suffering from unstable angina; (2) The patients enrolled included 68.1% males and 31.9% females; (3) The presenting symptoms as revealed in this study were chest pain in 1299 patients (91.1%); (4) shortness of breath 602 patients (42.3%) and syncope 187 patients (6.1%); (5) The mean age of patients was 52.2±10.7 years which is almost a decade earlier than seen in the West. (Jawai, 2006, p.1)
Stated to be the most startling disclosure in the study "was that the majority of the heart attack patients reach hospitals after a mean of 13.2±6.2 hours delay after the onset of symptoms. This means that the time for thrombolytic therapy to be of any use is already over. Only 50% of patients suffering from acute coronary syndrome were prescribed aspirin at the time of discharge from hospitals." (Jawai, 2006, p.1)
Jawai (2006) states the following facts: "While 71.7% patients were given Aspirin in wards only 59.9% of patients reaching the emergency room were given aspirin. About 20.8% of patients were prescribed aspirin therapy by the family physicians and only 16% took aspirin at home when they suffered from chest pain. Out of these 1400 patients, four hundred forty four (31.2%) were taking aspirin before the onset of symptoms. Findings of this study also showed that incidence of myocardial infarction has also increased in women to over 30% as against previously reported figures of 10-15%." (p.1) In the area of adverse reactions only 3.1% of patients had allergic reactions including G.I. (0.9%), bleeding (2.1%) as well as others (1.1%) which are stated to be "quite negligible proving once again the safety and efficacy of this wonder drug." (Jaiwai, 2006, p.1) Major risk factors stated to be contributing to acute coronary syndromes were "family history of hypertension 51.8% smoking 51.3%, hypertension 54.3%, family history of IHD 43.9% and family history of hyperli- pidemias 54.3%.
Other risk factors included family history of diabetes 35.6%, IHD 38.2%, diabetes mellitus 37.2% and hyperlipidemias 18%. Only 3% of the patients enrolled in the study died, 17% were referred for investigations and 13% were stable with symptoms." (Jawai,...
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