Dataset Information

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

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.

SUBMITTER: Gresnigt FMJ

PROVIDER: S-EPMC7770504 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Publications

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

Gresnigt Femke M J FMJ Gubbels Nanda P NP Riezebos Robert K RK

Toxicology reports 20201218

<h4>Introduction</h4>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.<h4>Methods</h4>An anonymous online questionnaire-based survey was conducted among Dutch eme ...[more]

PMID: 33384944

Similar Datasets

Project description:OBJECTIVE:To identify and assess the performance of clinical decision rules (CDR) for chest pain in general practice. DESIGN:Systematic review of diagnostic studies. DATA SOURCES:Medline/Pubmed, Embase/Ovid, CINAHL/EBSCO and Google Scholar up to October 2018. STUDY SELECTION:Studies that assessed CDRs for intermittent-type chest pain and for rule out of acute coronary syndrome (ACS) applicable in general practice, thus not relying on advanced laboratory, computer or diagnostic testing. REVIEW METHODS:Reviewers identified studies, extracted data and assessed the quality of the evidence (using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2)), independently and in duplicate. RESULTS:Eight studies comprising five CDRs met the inclusion criteria. Three CDRs are designed for rule out of coronary disease in intermittent-type chest pain (Gencer rule, Marburg Heart Score, INTERCHEST), and two for rule out of ACS (Grijseels rule, Bruins Slot rule). Studies that examined the Marburg Heart Score had the highest methodological quality with consistent sensitivity (86%-91%), specificity (61%-81%) and positive (23%-35%) and negative (97%-98%) predictive values (PPV and NPV). The diagnostic performance of Gencer (PPV: 20%-34%, NPV: 95%-99%) and INTERCHEST (PPV: 35%-43%, NPV: 96%-98%) appear comparable, but requires further validation. The Marburg Heart Score was more sensitive in detecting coronary disease than the clinical judgement of the general practitioner. The performance of CDRs that focused on rule out of ACS were: Grijseels rule (sensitivity: 91%, specificity: 37%, PPV: 57%, NPV: 82%) and Bruins Slot (sensitivity: 97%, specificity: 10%, PPV: 23%, NPV: 92%). Compared with clinical judgement, the Bruins Slot rule appeared to be safer than clinical judgement alone, but the study was limited in sample size. CONCLUSIONS:In general practice, there is currently no clinical decision aid that can safely rule out ACS. For intermittent chest pain, several rules exist, of which the Marburg Heart Score has been most extensively tested and appears to outperform clinical judgement alone.

Dataset Information

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

Introduction

Methods

Results

Conclusion

Publications

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

Similar Datasets

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