Evidence-Based Data Use in Clinical Practice

The dynamic shift in healthcare practices has influenced the adoption of innovative interventions that are based on evidence from research. Evidence-based practice (EBP) marks a shift from the traditional reliance on observations to an emphasis on data extracted from well-known studies. Today, evidence-based data stands as a beacon illuminating the path toward enhanced patient outcomes and enriched clinical decision-making. This essay explores the pivotal role of evidence-based data in managing patients with myocardial infarction. The study explores current evidence from different databases on the effectiveness of early versus late administration of aspirin to improve symptoms of myocardial infarction.

Database Overview

Databases relevant to my clinical question include Cochrane, Pubmed, and the National Institute of Cardiovascular Diseases web resource. Cochrane is one of the databases renowned for its collection of systematic reviews and meta-analyses, providing synthesized evidence on various healthcare topics. The article discussing the pretransfer administration of aspirin to manage myocardial infarction was located in this database. A second database utilized for this search was PubMed because of its comprehensive source of biomedical literature. This database offers a vast repository of research articles, clinical trials, systematic reviews, and meta-analyses. For example, the article discussing early versus late administration of aspirin for non-traumatic chest pain was retrieved from PubMed. The National Institute of Cardiovascular Diseases is a web resource that promotes clinical research on cardiovascular diseases like myocardial infarction. This database was used to locate the research article dealing with the early use of aspirin to manage ST elevation in patients with myocardial infarction.

Definition of Clinical Question

The clinical question selected for this discussion is the effectiveness of aspirin therapy in managing myocardial infarction. Aspirin is a known drug that has been used to immediately manage symptoms of cardiovascular disease through its action on platelet activation and aggregation (Djarv et al., 2020). Although this drug is supported to manage acute symptoms of cardiac disease including ST-elevation myocardial infarction (STEMI), there is a debate on its early versus late use. The decision of pretransfer aspirin administration seems to remain at the discretion of the physician raising the concern of which method yields better patient outcomes (Mal et al., 2023). To investigate this problem, a PICOT question was generated and used to search for relevant evidence from the above-mentioned databases.

WQT2 Performance Assessment Guidelines Consultative Change Recommendation

PICOT Question

In adult patients presenting to the emergency department with suspected myocardial infarction, does the immediate administration of aspirin, compared to delayed administration, result in a decrease in mortality rates and improvement in cardiac outcomes, within the first 24 hours of presentation?

Evidence Summary

Early use of aspirin after symptoms in patients with myocardial infarction is an intervention widely recognized to save lives. The standard guidelines recommend oral administration of 300mg of aspirin as soon as possible during emergency care (Mal et al., 2023). Research was conducted to determine the frequency of pre-hospital aspirin use in patients presenting with STEMI and to assess the demographic and clinical characteristics of those patients. Using a prospective study approach, 647 patients presenting with symptoms like chest pain and diagnosed with STEMI from Pakistan were sampled. The findings from the study indicate that prehospital administration of aspirin led to improved patient outcomes including decreased length of stay (Mal et al., 2023). In addition, factors like gender, educational status, and socioeconomic position were associated with aspirin use during emergencies. The researchers concluded that aspirin should be given to suspected myocardial infarction patients as soon as possible.

Percutaneous coronary intervention using antiplatelet therapies like aspirin is an established treatment for patients with STEMI. A study was conducted to determine whether pretransfer aspirin administration was associated with better angiographical outcomes in patients with STEMI. In this single-center observational study involving 326 patients, it was observed that patients who received pre-transfer aspirin had higher rates of achieving TIMI-3 flow at the first angiogram (Yamal et al., 2024). The study showed that pretransfer aspirin therapy was associated with early restoration of coronary blood flow in patients with STEMI.

Another study that utilized a systematic review approach was conducted to investigate the effect of early versus late administration of aspirin among adults with non-traumatic chest pain in improving survival, complications, and incidences of cardiac arrest. Based on findings from 1470 references, early administration of aspirin improved survival rates compared to late in-hospital administration (Djarv et al., 2020). Conflicting results were observed on the aspects of reducing complications and incidences of cardiac arrest from this study. The researchers concluded that early administration of aspirin to patients presenting with non-traumatic chest pain can increase the survival ratio as compared to late administration.

In conclusion, evidence-based data utilization stands as a beacon guiding clinical practice toward precision, efficacy, and patient-centered care. Utilizing evidence from research can help providers make informed decisions that can save lives and improve patient outcomes. Based on the research evidence on the role of aspirin therapy in managing STEMI, it can be concluded that the drug should be given early to patients for improvement of symptoms and survival rates.

References

Djarv, T., Swain, J. M., Chang, W. T., Zideman, D. A., & Singletary, E. (2020). Early or first aid administration versus late or in-hospital administration of aspirin for non-traumatic adult chest pain: A systematic review. Cureus, 12(2), e6862. https://doi.org/10.7759/cureus.6862

Mal, V., Ahmed, R., Asad, A., Batra, M. K., Ammar, A., Kumar, R., Hakeem, A., Khan, N. U., Sial, J. A., & Saghir, T. (2023). Early use of aspirin after symptoms in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Pakistan Heart Journal, 56(1), 17-21. https://doi.org/10.47144/phj.v56i1.2393

Yamada, R., Horikoshi, T., Nakamura, T., Uematsu, M., Yamaguchi, K., Kobayahi, T., … & Sato, A. (2024). Pretransfer aspirin administration and its impact on angiographic outcomes for patients with ST-elevation myocardial infarction. International Heart Journal, 65(1), 21-28. https://doi.org/10.1536/ihj.23-389