ASSESSMENT OF COCAINE USE IN PATIENTS WITH CHEST-PAIN-SYNDROMES

Background: Patients with myocardial ischemia may have different dispo sitions and/or pharmacologic interventions based on whether they have recently used cocaine. Objective: To determine the prevalence of asses sment of cocaine use in patients with acute chest pain syndromes. Meth ods: In phase 1 of the study, we reviewed the medical records of all p atients with chest pain who presented to the emergency department duri ng February 1996 to assess historical documentation of the presence or absence of cocaine use. In phase 2, we evaluated whether cocaine ques tions were asked but nut documented. After hospital admission, patient s were interviewed to see if they were asked about cocaine use. In pha se 3, we evaluated possible recall bias by using standardized question ing in the emergency department and used subsequent interviews to asse ss recall. Assessment of other cardiac risk factors served as the comp arison group. Resuts: In phase 1, 129 charts were reviewed, 13% of whi ch 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%), dia betes (73%), or family history (77%) (chi(2), P < .05 for all comparis ons). In phase 2, 27 (31%) of the 86 patients who were interviewed rec alled cocaine questioning. There was chart documentation of the cocain e questioning in only 44% of the 27 cases. In phase 3, while in the em ergency 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 recen t cocaine use. When they are asked, their answers are poorly documente d. These findings cannot be explained by poor recall. In cases of ches t pain, efforts to improve questioning of patients about cocaine use a re needed, since recent cocaine use may change treatment, disposition, and need for counseling.