Marin Nishimura1, Harpreet Bhatia1, Janet Ma1, Stephen D Dickson1, Laith Alshawabkeh1, Eric Adler1, Alan Maisel1, Michael H Criqui2, Barry Greenberg1, Isac C Thomas3. 1. Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego. 2. Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego; Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California, San Diego. 3. Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego. Electronic address: icthomas@ucsd.edu.
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.
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.
Authors: Přemysl Mladěnka; Lenka Applová; Jiří Patočka; Vera Marisa Costa; Fernando Remiao; Jana Pourová; Aleš Mladěnka; Jana Karlíčková; Luděk Jahodář; Marie Vopršalová; Kurt J Varner; Martin Štěrba Journal: Med Res Rev Date: 2018-01-05 Impact factor: 12.944
Authors: Michael Von Korff; Sascha Dublin; Rod L Walker; Michael Parchman; Susan M Shortreed; Ryan N Hansen; Kathleen Saunders Journal: J Pain Date: 2015-10-22 Impact factor: 5.820
Authors: Paul A Heidenreich; Nancy M Albert; Larry A Allen; David A Bluemke; Javed Butler; Gregg C Fonarow; John S Ikonomidis; Olga Khavjou; Marvin A Konstam; Thomas M Maddox; Graham Nichol; Michael Pham; Ileana L Piña; Justin G Trogdon Journal: Circ Heart Fail Date: 2013-04-24 Impact factor: 8.790
Authors: Justin M Vader; Shane J LaRue; Susanna R Stevens; Robert J Mentz; Adam D DeVore; Anuradha Lala; John D Groarke; Omar F AbouEzzeddine; Shannon M Dunlay; Justin L Grodin; Victor G Dávila-Román; Lisa de Las Fuentes Journal: J Card Fail Date: 2016-04-28 Impact factor: 5.712
Authors: Natalie A Bello; Brian Claggett; Akshay S Desai; John J V McMurray; Christopher B Granger; Salim Yusuf; Karl Swedberg; Marc A Pfeffer; Scott D Solomon Journal: Circ Heart Fail Date: 2014-05-29 Impact factor: 8.790
Authors: Mark D Huffman; Jarett D Berry; Hongyan Ning; Alan R Dyer; Daniel B Garside; Xuan Cai; Martha L Daviglus; Donald M Lloyd-Jones Journal: J Am Coll Cardiol Date: 2013-04-09 Impact factor: 24.094
Authors: Stephan Schürer; Karin Klingel; Marcus Sandri; Nicolas Majunke; Christian Besler; Reinhard Kandolf; Philipp Lurz; Michael Luck; Pia Hertel; Gerhard Schuler; Axel Linke; Norman Mangner Journal: JACC Heart Fail Date: 2017-06 Impact factor: 12.035
Authors: Paari Dominic; Javaria Ahmad; Hajra Awwab; Md Shenuarin Bhuiyan; Christopher G Kevil; Nicholas E Goeders; Kevin S Murnane; James C Patterson; Kristin E Sandau; Rakesh Gopinathannair; Brian Olshansky Journal: Circ Arrhythm Electrophysiol Date: 2021-12-28
Authors: Yeonwoo Kim; Sehun Oh; Paul J Fadel; Christopher P Salas-Wright; Michael G Vaughn Journal: Int J Environ Res Public Health Date: 2022-01-05 Impact factor: 3.390
Authors: Jakrin Kewcharoen; Andrew K Chang; Purvi Parwani; Gary Fraser; Aditya Bharadwaj; Ahmed Seliem; Diane Tran; Liset Stoletniy; Antoine Sakr; Dmitry Abramov Journal: Cardiol Res Date: 2022-04-05