"The emergency medicine community and the cardiology community really have not had any guidelines on how to manage these people," says Dr. Jim Edward Weber, an assistant professor of emergency medicine at the University of Michigan.
Weber is also lead author of the study, which appears in the Feb. 6 issue of The New England Journal of Medicine.
Guidelines are crucial, since an estimated 25 million Americans have used cocaine at least once, and 1.5 million of them have used it in the past month, according to the study. And the risk of a heart attack during the hour after cocaine use rises to 24 times normal, experts know.
However, determining which patients are at risk for heart problems can be difficult, especially since many patients deny their drug use when asked by the emergency department physician.
The problem is especially critical in hospital emergency departments in economically depressed areas, Weber says. "One in five patients between ages 18 and 50 with a chief complaint of chest pain have cocaine in their system," he says of this population.
The new study validates findings from previous research.
Weber and his colleagues evaluated 344 patients with cocaine-associated chest pain who sought care at Hurley Medical Center in Flint, Mich., where Weber is the director of research. Of those, 42 were admitted to the hospital for further evaluation because they were judged at high risk for heart problems. The other 302, mostly male with an average age of 37, were deemed "low-risk."
These low-risk patients were given electrocardiograms and a variety of other tests to determine if there was injury to the heart. After nine to 12 hours, they were discharged.
After 30 days, Weber's team followed up to determine the health status of the subjects and got detailed information on 256 of them. Four had had a nonfatal heart attack, and all four had continued to use cocaine. There were no deaths from cardiac causes, although two subjects died from other causes.
The strategy used for the cocaine-abusing patients with chest pain is similar to that used for people with chest pain who have not taken illegal drugs, Weber says, and the study suggests it works well.
Before discharging patients, Weber says, it's important to steer them to treatment programs for help for their drug problem.
Another emergency medicine expert says the study validates what his medical center, and many others, have been doing for several years.
"We do something very similar and have been doing it for quite a while," says Dr. Wally Ghurabi, medical director of the emergency center at Santa Monica-UCLA Medical Center in California.
"If a patient admits he has taken coke and has severe cardiac problems, we admit him. If he doesn't admit he took coke and has cardiac problems, we keep him for eight or nine hours and do all these [cardiac function] tests."
The new study, he adds, "formalizes what a lot of emergency departments in academic centers have been doing."
Ghurabi agrees with Weber that some cocaine-taking patients are apt to deny drug use when questioned by health-care providers, although there are exceptions.
"A lot of kids will tell the truth, they are so scared," Ghurabi says. "And the pain is so severe."