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Hospital Admissions for Chest Pain Associated with Cocaine Use in the United States
Vikas Singh1, Alex P Rodriguez2, Badal Thakkar3
1Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
Insights
Cocaine-induced chest pain admissions have low adverse outcomes. Ruling out acute coronary syndrome may prevent unnecessary hospitalizations and cardiac procedures for low-risk patients.
Area of Science:
- Cardiology
- Public Health
- Toxicology
Background:
- Chest pain associated with cocaine use is understudied.
- The healthcare burden of cocaine-related chest pain is not well understood.
Purpose of the Study:
- To investigate the outcomes and healthcare costs of chest pain admissions linked to cocaine use.
- To identify predictors of adverse events in patients presenting with cocaine-induced chest pain.
Main Methods:
- Utilized data from the Nationwide Inpatient Sample (2001-2012).
- Identified patients using International Classification of Diseases, Ninth Revision, Clinical Modification codes.
- Defined primary outcome as a composite of mortality, myocardial infarction, stroke, and cardiac arrest.
Main Results:
- Analyzed 363,143 admissions for cocaine-induced chest pain.
- Low rates of adverse outcomes observed: 0.09% in-hospital mortality and 1.19% for the primary outcome.
- Identified key predictors of adverse outcomes including female sex, age >50, heart failure history, supraventricular tachycardia, endocarditis, tobacco use, dyslipidemia, coronary artery disease, and renal failure.
- Estimated annual economic burden between $155-$226 million, exceeding $2 billion over a decade.
Conclusions:
- Hospital admissions for chest pain with cocaine use show low rates of adverse events.
- Hospitalization may not be beneficial for low-risk patients after ruling out acute coronary syndrome, potentially leading to unnecessary cardiac interventions.
Background:
The outcomes related to chest pain associated with cocaine use and its burden on the healthcare system are not well studied.
Methods:
Data were collected from the Nationwide Inpatient Sample (2001-2012). Subjects were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcome was a composite of mortality, myocardial infarction, stroke, and cardiac arrest.
Results:
We identified 363,143 admissions for cocaine-induced chest pain. Mean age was 44.9 (±21.1) years with male predominance. Left heart catheterizations were performed in 6.7%, whereas the frequency of acute myocardial infarction and percutaneous coronary interventions were 0.69% and 0.22%, respectively. The in-hospital mortality was 0.09%, and the primary outcome occurred in 1.19% of patients. Statistically significant predictors of primary outcome included female sex (odds ratio [OR], 1.16; confidence interval [CI], 1.00-1.35; P = .046), age >50 years (OR, 1.24, CI, 1.07-1.43; P = .004), history of heart failure (OR, 1.63, CI, 1.37-1.93; P <.001), supraventricular tachycardia (OR, 2.94, CI, 1.34-6.42; P = .007), endocarditis (OR, 3.5, CI, 1.50-8.18, P = .004), tobacco use (OR, 1.3, CI, 1.13-1.49; P <.001), dyslipidemia (OR, 1.5, CI, 1.29-1.77; P <.001), coronary artery disease (OR, 2.37, CI, 2.03-2.76; P <.001), and renal failure (OR, 1.27, CI, 1.08-1.50; P = .005). The total annual projected economic burden ranged from $155 to $226 million with a cumulative accruement of more than $2 billion over a decade.
Conclusion:
Hospital admissions due to chest pain and concomitant cocaine use are associated with low rates of adverse outcomes. For the low-risk cohort in whom acute coronary syndrome has been ruled out, hospitalization may not be beneficial and may result in unnecessary cardiac procedures.