Gresnigt Femke M J, Gubbels Nanda P, Riezebos Robert K
Emergency Physician, Emergency Department, OLVG Hospital, Oosterpark 9, 1091AC, Amsterdam, the Netherlands.
Emergency Medicine Resident, Emergency Department, OLVG Hospital, Oosterpark 9, 1091AC, Amsterdam, the Netherlands.
Toxicol Rep. 2020 Dec 18;8:23-27. doi: 10.1016/j.toxrep.2020.12.011. eCollection 2021.
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.
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.
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.
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.
可卡因被视为心血管危险因素，但常用的风险分层评分中并未纳入该因素。此外，许多指南在如何诊断和治疗可卡因相关性胸痛（CACP）方面提供的建议有限。本研究旨在确定荷兰各地急诊科和冠心病监护病房对CACP患者的当前诊疗实践。
在2015年7月至2016年2月期间，对荷兰的急诊医生和心脏病专家进行了一项基于在线问卷的匿名调查。问卷基于美国心脏协会的CACP治疗算法。
共有214名受试者参与并完成了问卷。所有受访者都认为使用可卡因是发生急性冠状动脉综合征（ACS）的危险因素，然而，74.4%的急诊医生和81.1%的心脏病专家并不总是询问胸痛患者是否使用过毒品。在所有受访者中，73.6%从未进行毒理学筛查。大多数受访者（60%）根据欧洲心脏病学会ACS指南对CACP患者进行观察，24.3%的受访者给这些患者使用β受体阻滞剂。
荷兰大多数急诊科和冠心病监护病房对CACP患者的当前诊疗实践与美国心脏协会的科学声明不一致。应建议急诊医生和心脏病专家常规询问所有胸痛患者的用药史，并意识到风险分层评分对CACP未经验证。尽管有2008年美国心脏协会的科学声明，但许多受访者仍对CACP患者使用β受体阻滞剂，自该声明发布以来的已发表证据支持这一做法。
