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

Abstract

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.

Keywords

• aspirin
• cardiovascular disease
• myocardial infarction
• prevention