Aspirin administration for cardiac-related acute chest pain/angina: increased use in Medicare patients.

BACKGROUND Coronary heart disease (CHD), the leading cause of death in the United States, accounted for approximately 490,000 deaths in 1993. Angina pectoris, a manifestation of CHD, accounted for 13,586 Medicare discharges in 1993 in Texas. A pilot project showed aspirin prophylaxis that reduces cardiovascular morbidity and mortality in individuals with acute angina is underused. Texas Medical Foundation collaborated with 10 acute-care facilities to improve aspirin prophylaxis. METHODS Collaborators assessed processes of care and implemented clinical pathways to improve aspirin administration. Data were abstracted from medical records before and after pathway implementation to evaluate impact. RESULTS Aspirin administration during hospital stay increased 10.8%, aspirin administration on discharge increased 11.7%, and average time from arrival to aspirin administration decreased 2.9 hours. CONCLUSIONS Results suggest collaborator-implemented clinical pathways significantly improved care received by Medicare patients admitted for cardiac-related acute chest pain/angina. Data suggest room for further improvement.