Substance abuse ups risk of heart failure hospitalizations, readmissions

Substance-abuse disorders (SADs) are not at all uncommon among patients with heart failure (HF), according to a study. Several SADs independently correlate with HF-related emergency department (ED) visits and hospitalizations.

“Evaluation of substance abuse history, particularly methamphetamine abuse, opioid use and abuse, and alcohol abuse, may identify patients at a greater risk for HF morbidity,” the researchers said. “Greater recognition and treatment of SADs may lead to improved outcomes among patients with HF.”

Medical records of HF patients treated at the University of California–San Diego from 2005 to 2016 were evaluated, and substance abuse was identified through diagnosis codes or urine drug screens. Incidence rate ratios (IRR) of substance abuse for ED visits or hospitalizations with a primary diagnosis of HF were estimated using Poisson regression, adjusted for age, sex, race, medical diagnoses and insurance status.

Over a follow-up of 49,712 person-years, a total of 11,269 HF patients and 15,909 hospital encounters for HF were identified. Of the patients, 15.2 percent were diagnosed with substance abuse. [Am J Med 2020;133:207-213.e1]

SADs such as methamphetamine abuse (prevalence, 5.2 percent; IRR, 1.96, 95 percent confidence interval [CI], 1.85–2.07), opioid use and abuse (prevalence, 8.2 percent; IRR, 1.54, 95 percent CI, 1.47–1.61), and alcohol abuse (prevalence, 4.5 percent; IRR, 1.51, 95 percent CI, 1.42–1.60) correlated with a higher rate of hospital encounters for HF.

These associations were comparable to other comorbidity diagnoses such as atrial fibrillation (prevalence, 37 percent; IRR, 1.78, 95 percent CI, 1.73–1.84), ischaemic heart disease (prevalence, 24 percent; IRR, 1.67, 95 percent CI, 1.62–1.73) and chronic kidney disease (prevalence, 26 percent; IRR, 1.57, 95 percent CI, 1.51–1.62).

The most commonly used substance was opioids, followed by methamphetamine, alcohol, marijuana and cocaine. Annual incidence of opioid use decreased over the study period from 9.6 percent to 4.1 percent, mirroring that in the general population. In contrast, methamphetamine abuse increased between 2006 and 2016 from 1.8 percent to 6.4 percent. [J Pain 2016;17:101-110]

Many abused substances have toxic effects, the researchers said. Cocaine, for instance, can cause several adverse cardiovascular effects, such as hypertension, myocardial ischaemia, arrhythmia, aortic dissection and stroke. [J Am Coll Cardiol 2017;70:101-113; Med Res Rev 2018;38:1332-1403]

Alcohol may also induce hypertension, as well as atrial fibrillation and alcoholic cardiomyopathy. Methamphetamine use is also associated with cardiovascular complications, including HF and pulmonary hypertension. [Med Res Rev 2018;38:1332-1403; Heart Lung Circ 2016;25:325-332; Circ Cardiol 2013;36:737-742]

However, despite the robust correlation between substance abuse and HF-related hospital encounters, no association was found between substance abuse and mortality, according to the researchers.

“It is likely that given relative youth of the patients with a substance abuse history, the baseline level of risk for mortality was lower among patients with [vs without] substance abuse,” they added.