Hospital Admissions for Chest Pain Associated with Cocaine Use in the United States

Vikas Singh, Alex P. Rodriguez, Badal Thakkar, Ghanshyambhai T. Savani, Nileshkumar J. Patel, Apurva O. Badheka, Mauricio G Cohen, Carlos E Alfonso, Raul Mitrani, Juan Viles Gonzalez, Jeffrey Goldberger

Research output: Contribution to journalArticle

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Abstract

Background: The outcomes related to chest pain associated with cocaine use and its burden on the healthcare system are not well studied. Methods: Data were collected from the Nationwide Inpatient Sample (2001-2012). Subjects were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcome was a composite of mortality, myocardial infarction, stroke, and cardiac arrest. Results: We identified 363,143 admissions for cocaine-induced chest pain. Mean age was 44.9 (±21.1) years with male predominance. Left heart catheterizations were performed in 6.7%, whereas the frequency of acute myocardial infarction and percutaneous coronary interventions were 0.69% and 0.22%, respectively. The in-hospital mortality was 0.09%, and the primary outcome occurred in 1.19% of patients. Statistically significant predictors of primary outcome included female sex (odds ratio [OR], 1.16; confidence interval [CI], 1.00-1.35; P = .046), age >50 years (OR, 1.24, CI, 1.07-1.43; P = .004), history of heart failure (OR, 1.63, CI, 1.37-1.93; P <.001), supraventricular tachycardia (OR, 2.94, CI, 1.34-6.42; P = .007), endocarditis (OR, 3.5, CI, 1.50-8.18, P = .004), tobacco use (OR, 1.3, CI, 1.13-1.49; P <.001), dyslipidemia (OR, 1.5, CI, 1.29-1.77; P <.001), coronary artery disease (OR, 2.37, CI, 2.03-2.76; P <.001), and renal failure (OR, 1.27, CI, 1.08-1.50; P = .005). The total annual projected economic burden ranged from $155 to $226 million with a cumulative accruement of more than $2 billion over a decade. Conclusion: Hospital admissions due to chest pain and concomitant cocaine use are associated with low rates of adverse outcomes. For the low-risk cohort in whom acute coronary syndrome has been ruled out, hospitalization may not be beneficial and may result in unnecessary cardiac procedures.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
DOIs
StateAccepted/In press - 2017

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Chest Pain
Cocaine
Odds Ratio
Confidence Intervals
Myocardial Infarction
Unnecessary Procedures
Supraventricular Tachycardia
Sex Ratio
Tobacco Use
International Classification of Diseases
Percutaneous Coronary Intervention
Acute Coronary Syndrome
Cardiac Catheterization
Dyslipidemias
Hospital Mortality
Endocarditis
Heart Arrest
Renal Insufficiency
Inpatients
Coronary Artery Disease

Keywords

  • Chest pain
  • Cocaine use
  • Mortality
  • Myocardial infarction
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Hospital Admissions for Chest Pain Associated with Cocaine Use in the United States. / Singh, Vikas; Rodriguez, Alex P.; Thakkar, Badal; Savani, Ghanshyambhai T.; Patel, Nileshkumar J.; Badheka, Apurva O.; Cohen, Mauricio G; Alfonso, Carlos E; Mitrani, Raul; Viles Gonzalez, Juan; Goldberger, Jeffrey.

In: American Journal of Medicine, 2017.

Research output: Contribution to journalArticle

Singh, Vikas ; Rodriguez, Alex P. ; Thakkar, Badal ; Savani, Ghanshyambhai T. ; Patel, Nileshkumar J. ; Badheka, Apurva O. ; Cohen, Mauricio G ; Alfonso, Carlos E ; Mitrani, Raul ; Viles Gonzalez, Juan ; Goldberger, Jeffrey. / Hospital Admissions for Chest Pain Associated with Cocaine Use in the United States. In: American Journal of Medicine. 2017.
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abstract = "Background: The outcomes related to chest pain associated with cocaine use and its burden on the healthcare system are not well studied. Methods: Data were collected from the Nationwide Inpatient Sample (2001-2012). Subjects were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcome was a composite of mortality, myocardial infarction, stroke, and cardiac arrest. Results: We identified 363,143 admissions for cocaine-induced chest pain. Mean age was 44.9 (±21.1) years with male predominance. Left heart catheterizations were performed in 6.7{\%}, whereas the frequency of acute myocardial infarction and percutaneous coronary interventions were 0.69{\%} and 0.22{\%}, respectively. The in-hospital mortality was 0.09{\%}, and the primary outcome occurred in 1.19{\%} of patients. Statistically significant predictors of primary outcome included female sex (odds ratio [OR], 1.16; confidence interval [CI], 1.00-1.35; P = .046), age >50 years (OR, 1.24, CI, 1.07-1.43; P = .004), history of heart failure (OR, 1.63, CI, 1.37-1.93; P <.001), supraventricular tachycardia (OR, 2.94, CI, 1.34-6.42; P = .007), endocarditis (OR, 3.5, CI, 1.50-8.18, P = .004), tobacco use (OR, 1.3, CI, 1.13-1.49; P <.001), dyslipidemia (OR, 1.5, CI, 1.29-1.77; P <.001), coronary artery disease (OR, 2.37, CI, 2.03-2.76; P <.001), and renal failure (OR, 1.27, CI, 1.08-1.50; P = .005). The total annual projected economic burden ranged from $155 to $226 million with a cumulative accruement of more than $2 billion over a decade. Conclusion: Hospital admissions due to chest pain and concomitant cocaine use are associated with low rates of adverse outcomes. For the low-risk cohort in whom acute coronary syndrome has been ruled out, hospitalization may not be beneficial and may result in unnecessary cardiac procedures.",
keywords = "Chest pain, Cocaine use, Mortality, Myocardial infarction, Percutaneous coronary intervention",
author = "Vikas Singh and Rodriguez, {Alex P.} and Badal Thakkar and Savani, {Ghanshyambhai T.} and Patel, {Nileshkumar J.} and Badheka, {Apurva O.} and Cohen, {Mauricio G} and Alfonso, {Carlos E} and Raul Mitrani and {Viles Gonzalez}, Juan and Jeffrey Goldberger",
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T1 - Hospital Admissions for Chest Pain Associated with Cocaine Use in the United States

AU - Singh, Vikas

AU - Rodriguez, Alex P.

AU - Thakkar, Badal

AU - Savani, Ghanshyambhai T.

AU - Patel, Nileshkumar J.

AU - Badheka, Apurva O.

AU - Cohen, Mauricio G

AU - Alfonso, Carlos E

AU - Mitrani, Raul

AU - Viles Gonzalez, Juan

AU - Goldberger, Jeffrey

PY - 2017

Y1 - 2017

N2 - Background: The outcomes related to chest pain associated with cocaine use and its burden on the healthcare system are not well studied. Methods: Data were collected from the Nationwide Inpatient Sample (2001-2012). Subjects were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcome was a composite of mortality, myocardial infarction, stroke, and cardiac arrest. Results: We identified 363,143 admissions for cocaine-induced chest pain. Mean age was 44.9 (±21.1) years with male predominance. Left heart catheterizations were performed in 6.7%, whereas the frequency of acute myocardial infarction and percutaneous coronary interventions were 0.69% and 0.22%, respectively. The in-hospital mortality was 0.09%, and the primary outcome occurred in 1.19% of patients. Statistically significant predictors of primary outcome included female sex (odds ratio [OR], 1.16; confidence interval [CI], 1.00-1.35; P = .046), age >50 years (OR, 1.24, CI, 1.07-1.43; P = .004), history of heart failure (OR, 1.63, CI, 1.37-1.93; P <.001), supraventricular tachycardia (OR, 2.94, CI, 1.34-6.42; P = .007), endocarditis (OR, 3.5, CI, 1.50-8.18, P = .004), tobacco use (OR, 1.3, CI, 1.13-1.49; P <.001), dyslipidemia (OR, 1.5, CI, 1.29-1.77; P <.001), coronary artery disease (OR, 2.37, CI, 2.03-2.76; P <.001), and renal failure (OR, 1.27, CI, 1.08-1.50; P = .005). The total annual projected economic burden ranged from $155 to $226 million with a cumulative accruement of more than $2 billion over a decade. Conclusion: Hospital admissions due to chest pain and concomitant cocaine use are associated with low rates of adverse outcomes. For the low-risk cohort in whom acute coronary syndrome has been ruled out, hospitalization may not be beneficial and may result in unnecessary cardiac procedures.

AB - Background: The outcomes related to chest pain associated with cocaine use and its burden on the healthcare system are not well studied. Methods: Data were collected from the Nationwide Inpatient Sample (2001-2012). Subjects were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcome was a composite of mortality, myocardial infarction, stroke, and cardiac arrest. Results: We identified 363,143 admissions for cocaine-induced chest pain. Mean age was 44.9 (±21.1) years with male predominance. Left heart catheterizations were performed in 6.7%, whereas the frequency of acute myocardial infarction and percutaneous coronary interventions were 0.69% and 0.22%, respectively. The in-hospital mortality was 0.09%, and the primary outcome occurred in 1.19% of patients. Statistically significant predictors of primary outcome included female sex (odds ratio [OR], 1.16; confidence interval [CI], 1.00-1.35; P = .046), age >50 years (OR, 1.24, CI, 1.07-1.43; P = .004), history of heart failure (OR, 1.63, CI, 1.37-1.93; P <.001), supraventricular tachycardia (OR, 2.94, CI, 1.34-6.42; P = .007), endocarditis (OR, 3.5, CI, 1.50-8.18, P = .004), tobacco use (OR, 1.3, CI, 1.13-1.49; P <.001), dyslipidemia (OR, 1.5, CI, 1.29-1.77; P <.001), coronary artery disease (OR, 2.37, CI, 2.03-2.76; P <.001), and renal failure (OR, 1.27, CI, 1.08-1.50; P = .005). The total annual projected economic burden ranged from $155 to $226 million with a cumulative accruement of more than $2 billion over a decade. Conclusion: Hospital admissions due to chest pain and concomitant cocaine use are associated with low rates of adverse outcomes. For the low-risk cohort in whom acute coronary syndrome has been ruled out, hospitalization may not be beneficial and may result in unnecessary cardiac procedures.

KW - Chest pain

KW - Cocaine use

KW - Mortality

KW - Myocardial infarction

KW - Percutaneous coronary intervention

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