The Impact of Substance Abuse on Heart Failure Hospitalizations - PubMed (original) (raw)

The Impact of Substance Abuse on Heart Failure Hospitalizations

Marin Nishimura et al. Am J Med. 2020 Feb.

Abstract

Background: The burden of substance abuse among patients with heart failure and its association with subsequent emergency department visits and hospital admissions are poorly characterized.

Methods: We evaluated the medical records of patients with a diagnosis of heart failure treated at the University of California-San Diego from 2005 to 2016. We identified substance abuse via diagnosis codes or urine drug screens. We used Poisson regression to evaluate the incidence rate ratios (IRR) of substance abuse for emergency department visits or hospitalizations with a primary diagnosis of heart failure, adjusted for age, sex, race, medical insurance status, and medical diagnoses.

Results: We identified 11,268 patients with heart failure and 15,909 hospital encounters for heart failure over 49,712 person-years of follow-up. Substance abuse was diagnosed in 15.2% of patients. Disorders such as methamphetamine abuse (prevalence 5.2%, IRR 1.96, 95% confidence interval [CI] 1.85-2.07), opioid use and abuse (8.2%, IRR 1.54, 95% CI 1.47-1.61), and alcohol abuse (4.5%, IRR 1.51, 95% CI 1.42-1.60) were associated with a greater number of hospital encounters for heart failure, with associations that were comparable to diagnoses such as atrial fibrillation (37%, IRR 1.78, 95% CI 1.73-1.84), ischemic heart disease (24%, IRR 1.67, 95% CI 1.62-1.73), and chronic kidney disease (26%, IRR 1.57, 95% CI 1.51-1.62).

Conclusions: Although less prevalent than common medical comorbidities in patients with heart failure, substance-abuse disorders are significant sources of morbidity that are independently associated with emergency department visits and hospitalizations for heart failure. Greater recognition and treatment of substance abuse may improve outcomes among patients with heart failure.

Keywords: Heart failure; Readmission; Substance abuse.

Copyright © 2019 Elsevier Inc. All rights reserved.

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Conflict of interest statement

Disclosures: All of the authors report no conflicts of interest related to this manuscript. All authors had had access to the data and a role in writing the manuscript

Figures

Figure 1:

Figure 1:. Trends in substance abuse among patients with heart failure, 2006–2016.

The annual incidence of substance use disorders among patients with heart failure treated at the University of California, San Diego are plotted. Patients with heart failure were identified based on ICD-9 diagnosis code 428.xx. Substance abuse was defined by a urine drug toxicology test positive for the given drug or the presence of the relevant ICD-9 code.

Figure 2:

Figure 2:. Risks of hospital encounter for heart failure associated with medical and drug abuse diagnoses.

Incidence rate ratios and 95% confidence intervals are plotted. 11,268 patients with a history of heart failure were evaluated in a multivariable Poisson regression model for the number of emergency department visits and/or hospitalizations with a primary encounter diagnosis of heart failure. Over a median follow-up of 3.6 years (interquartile range 1.6 to 6.9 years), 15,909 heart failure hospital encounters occurred. The multivariable model includes mutual adjustment for the variables listed above as well as age, sex, race/ethnicity, and medical insurance status. Red bars indicate substance abuse disorders and blue bars indicate medical diagnoses

Figure 3:

Figure 3:. Risks of heart failure readmission associated with medical and drug abuse diagnoses.

Hazard ratios and 95% confidence intervals are plotted. 6,283 patients with a prior hospital admission with heart failure as the primary admission diagnosis were evaluated in a multivariable Cox regression model for time to first readmission with heart failure as the primary admission diagnosis. Over a median follow-up of 324 days (interquartile range 47 to 947 days), 2,857 heart failure readmissions occurred. Multivariable model includes mutual adjustment for the variables listed above as well age, sex, race/ethnicity, and medical insurance status. Red bars indicate substance abuse disorders and blue bars indicate medical diagnoses

Figure 4:

Figure 4:. Risks of all-cause mortality associated with medical and drug abuse diagnoses.

Hazard ratios and 95% confidence intervals are plotted. 11,268 patients with a history of heart failure were evaluated in a multivariable Cox regression model for time to all-cause mortality. Over a median follow-up of 324 days (interquartile range 47 to 947 days), 2,094 deaths occurred. Multivariable model includes mutual adjustment for the variables listed above as well age, sex, race/ethnicity, and medical insurance status.

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