Evaluating Clinical Question Publication

Cardiovascular disease continues to be the leading clinical and public health problem in many countries worldwide. Administering aspirin during cardiovascular events like myocardial infarction is one of the widely recognized interventions. Clinical guidelines recommend the administration of aspirin to inhibit platelet aggregation and formation of blood clots (Djarv et al., 2020). An episode of ST-segment elevation myocardial infarction (STEMI) is more lethal and a debate exists between the effectiveness of early administration of aspirin versus in-hospital use of the medication. This discussion focuses on the question of early versus late administration of aspirin to manage STEMI as supported by evidence from research.

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?

This PICOT question relates to my clinical practice setting because it deals with the adult population seeking care due to cardiovascular events. In my clinical setting, patients with cardiovascular diseases are the majority and represent a significant number of those seeking emergency services. Apart from the patient population, the clinical question highlights the use of aspirin therapy to improve outcomes in patients with STEMI. This intervention is directly applicable to clinical practice settings, as it involves a simple and widely available treatment that can be readily implemented by emergency healthcare providers (Yamada et al., 2024). The question also addresses the clinical outcome of reducing mortality rates which is among the facility’s key performance indicators. These outcomes are critically important in the acute management of MI patients and directly impact clinical decision-making and patient care in the ED setting.

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The clinical question presented has grown over time through research and clinical evidence. In the early 1980s, it was discovered that aspirin could inhibit platelet aggregation and prevent the formation of blood clots (Davidson et al., 2022). Studies conducted in the 1980s and 1990s demonstrated the efficacy of aspirin therapy in reducing mortality and improving outcomes in patients with MI (Djarv et al., 2020). Ever since research has been conducted to determine its effects when given early and when given later when managing patients with STEMI. This research question can further grow to include research on the optimal dose and timing of aspirin administration for maximum benefit in patients presenting with myocardial infarction.

Publication Sources

Journals specializing in emergency medicine and cardiovascular research may be interested in my research question. The Journal of the American College of Cardiology (JACC) is one of the publishers that may find my topic interesting. The Circulation Journal is another platform that focuses on valuable research, editorials, and informative reviews regarding cardiovascular disease management. Annals of Emergency Medicine is a leading journal in the field of emergency medicine, publishing high-quality research articles, systematic reviews, and case reports relevant to emergency care. This journal may be interested in my question because it deals with the emergency management of STEMI. The American Journal of Emergency Medicine is another similar publisher that may find my find my topic interesting. The question deals with acute care of STEMI and emergency management of the condition using aspirin therapy. A study evaluating the impact of aspirin on STEMi would align well with the scope of this journal.

Collaborative Practice Opportunities

Research development in the issue of STEMI management has benefited from various collaborative practices among healthcare professionals and other teams. For example, the International Liaison Committee on Resuscitation (ILCOR) has collaborated with many hospitals worldwide to study myocardial infarction treatment (Yamada et al., 2024). Collaborative opportunities that would involve the fields of cardiology and emergency medicine can help to investigate unanswered questions related to aspirin therapy in myocardial infarction. A multidisciplinary team approach can be used to conduct randomized controlled trials and prospective studies to advance the understanding of optimal treatment strategies for STEMI. In addition, opportunities for collaborative quality improvement projects can be taken to evaluate the current practices related to aspirin administration in patients with STEMI.

Guideline Review

The US Preventive Services Task Force (USPSTF) provides a guideline for aspirin use to manage cardiovascular events including myocardial infarction and stroke. The task force commissioned a systematic review to determine the effectiveness of aspirin in decreasing cardiovascular mortality and the risk for STEMI in people without a history of cardiovascular disease. Focusing on adults, the guideline recommends that aspirin use for those aged 40 to 59 years who have a 10% or greater cardiovascular disease risk has a small net benefit (Davidson et al., 2022). The task force also recommends that the decision to initiate aspirin therapy for the prevention of cardiovascular disease should be an individual one. Regarding secondary prevention of cardiovascular disease, the guideline recommends dual antiplatelet therapy which entails aspirin plus another drug with aspirin continued indefinitely (Davidson et al., 2022). This guideline is followed in the healthcare system because aspirin is given immediately after suspected acute myocardial infarction and continued for several days using a low-dose regimen to prevent another attack.

References

Davidson, K. W., Barry, M. J., Mangione, C. M., Cabana, M., Chelmow, D., Coker, T. R., Davis, E. M., Donahue, K. E., Jaén, C. R., Krist, A. H., Kubik, M., Li, L., Ogedegbe, G., Pbert, L., Ruiz, J. M., Stevermer, J., Tseng, C. W., & Wong, J. B. (2022). Aspirin use to Prevent cardiovascular disease: US Preventive Services Task Force Recommendation Statement. JAMA, 327(16), 1577–1584. https://doi.org/10.1001/jama.2022.4983

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

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