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Judd E. Hollander, MD; Daniel E. Brooks, MD; Sharon M. Valentine, RN, MS

Arch Intern Med. 1998;158:62-66.

Background  Patients with myocardial ischemia may have different dispositions and/or pharmacologic interventions based on whether they have recently used cocaine.

Objective  To determine the prevalence of assessment of cocaine use in patients with acute chest pain syndromes.

Methods  In phase 1 of the study, we reviewed the medical records of all patients with chest pain who presented to the emergency department during February 1996 to assess historical documentation of the presence or absence of cocaine use. In phase 2, we evaluated whether cocaine questions were asked but not documented. After hospital admission, patients were interviewed to see if they were asked about cocaine use. In phase 3, we evaluated possible recall bias by using standardized questioning in the emergency department and used subsequent interviews to assess recall. Assessment of other cardiac risk factors served as the comparison group.

Results  In phase 1, 129 charts were reviewed, 13% of which revealed myocardial infarction. The presence or absence of cocaine use (13%) was less frequently documented than the presence or absence of hypercholesterolemia (58%), hypertension (82%), smoking (90%), diabetes (73%), or family history (77%) (², P<.05 for all comparisons). In phase 2, 27 (31%) of the 86 patients who were interviewed recalled cocaine questioning. There was chart documentation of the cocaine questioning in only 44% of the 27 cases. In phase 3, while in the emergency department, 20 patients were asked about cocaine use: 19 (95%) recalled being asked about cocaine use when interviewed the next day.

Conclusions  Patients with chest pain often are not asked about recent cocaine use. When they are asked, their answers are poorly documented. These findings cannot be explained by poor recall. In cases of chest pain, efforts to improve questioning of patients about cocaine use are needed, since recent cocaine use may change treatment, disposition, and need for counseling.

From the Department of Emergency Medicine, University Medical Center, Stony Brook, NY. Dr Hollander is now with the Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia.

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