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Vol. 67. Issue 11.
Pages 966-967 (November 2014)
Vol. 67. Issue 11.
Pages 966-967 (November 2014)
Letter to the Editor
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The Epidemiology of Clinical and Health Effects Associated With Cocaine
Epidemiología de los efectos clínico-asistenciales asociados al consumo de cocaína
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Clara Gironés-Bredya,b, Miguel Galiciac, Alberto Domínguez-Rodríguezd,e, Guillermo Burillo-Putzea,b,
Corresponding author
gburillo@telefonica.net

Corresponding author:
a Servicio de Urgencias, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
b Departamento de Medicina Física y Farmacología, Facultad de Ciencias de la Salud, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
c Área de Urgencias, Hospital Clínic, Barcelona, Spain
d Servicio de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
e Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain
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Miguel Gili, Gloria Ramírez, Luis Béjar, Julio López, Dolores Franco, José Sala
Miguel Gili, Gloria Ramírez, Luis Béjar, Julio López
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To the Editor,

For the first time in Spain, a large population-based multicenter study confirmed the prolongation of hospital stay and has quantified the related costs in patients admitted for acute myocardial infarction associated with cocaine use. Moreover, the report provides complementary data on annual hospital admissions attributable to cocaine (0.44%) and on the incidence of acute myocardial infarctions due to its consumption (2.2%).1 However, we would like to comment on certain aspects that we believe could complement the epidemiological data provided in that report.

As the authors indicate in their article, there may be a risk of underreporting and underestimation of the prevalence, as we do not know whether the diagnosis of cocaine use was corroborated by an analytical study or was based solely on the patient's medical history. In the series described by Rodríguez-Esteban et al2 involving hospitalized patients with acute coronary syndrome, the prevalence of cocaine use was somewhat higher (3.7%), although that study showed the same methodological bias. These authors carried out a greater number of coronary angiographies (94% vs 82.4%; P<.01), but most of the patients had no significant coronary lesions or had single-vessel disease. Unfortunately, the authors did not evaluate the length or costs of the hospital stays.

The 1996-2009 Report on Emergency Hospital Care for users of psychoactive substances issued by the Spanish National Plan on Drugs,3 based on data from 2009, included patients with diagnoses coded according to the 10th revision of the International Classification of Diseases (ICD-10) and whose medical history made reference to cocaine consumption. In this report, the latter was the most commonly used drug (61.3%), and the incidence of hospital admission ranged between 7.2% and 9.8%, depending on whether there was a direct or a secondary relationship between cocaine use and the need for hospital care. In a review carried out by our group based on data on emergency care in cocaine users,4 cardiovascular symptoms were detected in 30% (standard deviation, 22.7%).

As the authors point out, there may also be cases of undisclosed cocaine use which, according to our findings in emergency departments, ranges between 6.4% and 21%, depending on the populations studied and the diagnosis or the reported reason for consultation.5–7 Likewise, some patients may have taken a substance other than cocaine.8 However, in this case, it would have no bearing on the phenomenon of cardiovascular risk associated with chronic use or on prevention strategies. As the authors indicate, all this may increase the impact of cocaine, although perhaps the economic costs could go in the opposite direction.

In cost analyses, it is also necessary to take into account previous visits to the emergency department by these patients, with the resulting health care expense or cost associated with cocaine consumption. Other elements to consider are cases of sudden death in the out-of-hospital setting9 and repeat emergency department visits.10 Lastly, since the study covered a 3-year period, some patients probably experienced more than one coronary ischemic event requiring hospital readmission.11

Finally, we agree with Gili et al that interventions aimed at identifying the risks associated with the use of these substances and the treatment of addiction are essential for the prevention of recurrence of cardiovascular events in this patient group, and an important part of the hospital stay should be devoted to these aims, although it may prolong hospitalization.10

References
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M. Gili, G. Ramírez, L. Béjar, J. López, D. Franco, J. Sala.
Trastornos por cocaína e infarto de miocardio, prolongación de estancias y exceso de costes hospitalarios.
Rev Esp Cardiol., 67 (2014), pp. 545-551
[2]
M. Rodríguez-Esteban, J. Mesa-Fumero, M. Facenda-Lorenzo, C. Dorta-Macías, M. Ramos-López, E. Soriano-Vela.
Síndrome coronario agudo y cocaína.
Med Clin (Barc)., 133 (2009), pp. 132-134
[3]
Plan Nacional sobre Drogas. Indicador Urgencias Hospitalarias en consumidores de sustancias psicoactivas, 1996-2009 [accessed 7 Jul 2014]. Available at: http://www.pnsd.msc.es/Categoria2/observa/pdf/IndicadorUrgencias1996_2009.pdf
[4]
M. Galicia, S. Nogué, G. Burillo-Putze.
Diez años de asistencias urgentes a consumidores de cocaína en España.
Med Clin (Barc)., 143 (2014), pp. 322-326
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G. Burillo-Putze, J.M. Borreguero León, E. Vallbona Afonso, A.M. de Vera González, J.F. Fernández Rodríguez, J.A. García Dopico, et al.
Consumo de cocaína y su relación con patología cardiaca y traumática atendida en un servicio de urgencias.
Emergencias., 20 (2008), pp. 380-384
[6]
G. Burillo-Putze, J.M. Borreguero León, J.A. García Dopico, J.F. Fernández Rodríguez, M.A. Pérez Carrillo, M.J. Jorge Pérez, et al.
Incidence and impact of undisclosed cocaine use in emergency department chest pain and trauma patients.
Int J Emerg Med., 1 (2008), pp. 169-172
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G. Burillo-Putze, B. López, J.M. Borreguero León, M. Sánchez Sánchez, M. García González, A. Domínguez Rodríguez, et al.
Undisclosed cocaine use and chest pain in emergency departments of Spain.
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A. Riveros Frutos, M. Martínez-Morillo, B. Tejera Segura, A. Olivé Marqués.
Cocaína y levamisol: una combinación ilícita.
Emergencias., 25 (2013), pp. 153-154
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J. Lucena, M. Blanco, C. Jurado, A. Rico, M. Salguero, R. Vázquez, et al.
Cocaine-related sudden death: a prospective investigation in south-west Spain.
Eur Heart J., 31 (2010), pp. 318-329
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M. Galicia, S. Nogué, X. Casañas, M.L. Iglesias, J. Puiguriguer, A. Supervía, et al.
Multicenter assessment of the revisit risk for a further drug-related problem in the emergency department in cocaine users (MARRIED-cocaine study).
Clin Toxicol., 50 (2012), pp. 176-182
[11]
A. Reina Toral, M. Colmenero Ruiz, C. García Pérez, M. Expósito Ruiz, E. de Antonio Martín, C. Bermúdez Tamayo, et al.
Diferencias en los resultados de la atención a los pacientes con síndrome coronario agudo con elevación del segmento ST (SCACEST) en función del acceso inicial a hospitales con o sin sala de hemodinámica en Andalucía.
Emergencias., 26 (2014), pp. 101-108
Copyright © 2014. Sociedad Española de Cardiología
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