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. 2020 Dec 18:8:23-27.
doi: 10.1016/j.toxrep.2020.12.011. eCollection 2021.

The current practice for cocaine-associated chest pain in the Netherlands

Femke M J Gresnigt  1 , Nanda P Gubbels  2 , Robert K Riezebos  3
Affiliations

The current practice for cocaine-associated chest pain in the Netherlands

Femke M J Gresnigt et al. Toxicol Rep. .

Abstract

Introduction: Cocaine is considered a cardiovascular risk factor, yet it is not included in the frequently used risk stratification scores. Moreover, many guidelines provide limited advice on how to diagnose and treat cocaine-associated chest pain (CACP). This study aimed to determine the current practice for CACP patients in emergency departments and coronary care units throughout the Netherlands.

Methods: An anonymous online questionnaire-based survey was conducted among Dutch emergency physicians and cardiologists between July 2015 and February 2016. The questionnaire was based on the American Heart Association CACP treatment algorithm.

Results: A total of 214 subjects were enrolled and completed the questionnaire. All responders considered cocaine use a risk factor for developing acute coronary syndrome (ACS), nevertheless 74.4 % of emergency physicians and 81.1 % of cardiologists do not always question chest pain patients about drug use. Of all responders, 73.6 % never perform toxicology screening. Most responders (60 %) observe patients with CACP according to the European Society of Cardiology ACS guideline, and 24.3 % give these patients ß-blockers.

Conclusion: The current practice for CACP patients in most emergency departments and coronary care units in the Netherlands is not in line with the AHA scientific statement. Emergency physicians and cardiologists should be advised to routinely question all chest pain patients on drug history and be aware that the risk stratifications scores are not validated for CACP. Despite the AHA scientific statement of 2008, many respondents utilize ß-blockers for CACP patients, which is supported by published evidence since the statement appeared.

Keywords: Chest pain; Cocaine; Observation.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

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References

    1. instituut T. Nationale drug monitor jaarbericht 2016 2017 [Available from: https://www.trimbos.nl/actueel/nieuws/bericht/jaarbericht-2016-van-de-nationale-drug-monitor-verschenen.
    1. Amsterdam E.A., Wenger N.K., Brindis R.G. AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the american college of cardiology/american heart association task force on practice guidelines. J. Am. Coll. Cardiol. 2014;2014(64):139–228. - PubMed
    1. O’Gara P.T., Kushner F.G., Ascheim D.D. ACCF/AHA guideline for the management of ST-elevation myocardial infarction. JACC. 2013;61(4):78–140. 2013. - PubMed
    1. Collet J.P., Thiele H., Barbato E. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur. Heart J. 2020;2020(00):1–79. - PubMed
    1. Ibanez B., James S., Agewall S. ESC Guidelines for the management of Acute myocardial infarction in patients presenting with ST-segment elevation. Eur. Heart J. 2017;2018(39):119–177. - PubMed

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