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While the differential diagnosis of chest pain (CP) is vast and commonly benign, cardiac causes can be deadly. Cocaine use can cause CP resulting in acute and chronic cardiovascular complications. In the US, cocaine is the second most abused drug with a higher incidence of consumption among young patients, those of middle to low economic means, and in urban areas. In an urban academic hospital in NYC with high rates of cocaine abuse, we sought to investigate the depth of inpatient CP workup with a focus on cocaine testing as a surrogate marker.
In a Medical Center in NYC we surveyed all internal medicine residents and floor attendings regarding the utility, perceptions, and potential barriers of cocaine testing in young patients admitted for CP. Additionally, a retrospective analysis was conducted of all patients ≤40yo hospitalized with a primary diagnosis of chest pain between 2010-2011. Charts were searched to determine if testing was ordered and urine collected.
Of 110 physicians surveyed, 57 completed the survey of young patients admitted with CP. Among respondents, 85% expressed cocaine testing as important in patient care while 86% reported that test results would affect their management. 97% were not morally opposed to testing if the patient denied cocaine use. Retrospective data revealed 139 young patients admitted for CP (age 33.9±5.7). Cocaine testing was ordered in 48% of patients with 73% having a collected sample. Of those collected, 73% were collected by ED staff. Overall, 60% of all patients <40yo were not tested for cocaine use during their hospitalization. 8% of patients tested had a positive test.
In an urban hospital center in NYC, cocaine testing of young patients hospitalized for CP was identified by physicians as being essential in patient diagnosis and management. However, discordantly, few patients were tested for cocaine use. The role of cocaine testing and the comprehensiveness of inpatient workup in this population warrants further multicenter studies to ensure optimum patient care.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Chest Pain and MI: The Good, the Bad and the Readmission Rate
Abstract Category: 22. Performance Improvement
Presentation Number: 1132-272
- 2013 American College of Cardiology Foundation