Fw: UT Southwestern News Release Feb. 5, 2003

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NEW STUDY VALIDATES FIRST-EVER CRITERIA FOR SAFE AND RAPID TREATMENT OF

PATIENTS WITH COCAINE-RELATED CHEST PAIN

DALLAS – Feb. 6, 2003 - Close observation and testing of patients with

cocaine-related chest pain in the first 12 hours after diagnosis is

sufficient to safely determine the risk of heart complications, according to

a researcher at UT Southwestern Medical Center at Dallas.

The findings, published in today's New England Journal of Medicine, will

help emergency departments develop standardized criteria for the safe and

rapid discharge of patients with cocaine-associated chest pain, said Dr.

Greg Larkin, UT Southwestern professor of emergency medicine, who designed

the study.

With the new criteria, hospitals could avoid unnecessary patient stays,

saving millions of dollars.

" This study boldly suggests that you don't have to be frightened to send

patients home with cocaine-associated chest pain, provided you do certain

tests first, " Larkin said. " This can be reassuring to physicians and

patients alike. "

During the hour after cocaine is used, the risk of heart attack increases

24-fold. Cocaine accounts for up to 25 percent of heart attacks in patients

between the ages of 18 and 45.

The study evaluated 344 patients with cocaine-associated chest pain. Of

these, 42 were at high risk for cardiovascular complications and were

admitted to the hospital. The remaining 302 were evaluated for nine to 12

hours after reporting to the emergency room, and physicians attempted to

follow them for 30 days to record any further medical problems.

Researchers found that patients who did not show evidence of heart-muscle

damage, impaired circulation or cardiovascular complications during the

12-hour observation period had a very low risk of death, blocked coronary

blood vessels, or other problems in the 30 days after discharge. Of the 256

patients for whom detailed follow-up information was available, only four

had nonfatal heart attacks during the 30 days after discharge. All four had

continued to use cocaine after their release and had at least two other

cardiac risk factors.

In 2000, there were 175,000 cocaine-related visits to U.S. emergency rooms.

Forty percent of those patients reported chest discomfort, 57 percent of

whom were admitted to hospitals for an average of three days. The cost to

hospitals of caring for these patients exceeds $83 million annually,

according to the study.

" Here at Parkland Memorial Hospital, we see dozens of chest-pain patients

every day, " Larkin said. " Some have used cocaine, and we admit a lot of

them. Why? Because we don't have a process currently in place where we can

rapidly rule them out for cardiac disease and safely send them home. "

Larkin's study offers specific treatment criteria to physicians treating

these patients. The treatment, however, requires a chest-pain observation

unit within an emergency room, which is currently available only at a

limited number of emergency rooms across the country. Hurley Medical Center

in Flint, Mich., has such a unit, which is where most of the patients in

this study were evaluated.

Other authors of the study included researchers from the University of

Michigan Medical School, Hurley Medical Center, the Hospital of the

University of Pennsylvania in Philadelphia and Northwestern University

Medical School.

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This news release is available on our World Wide Web home page at

http://www.utsouthwestern.edu/home_pages/news/

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