Abstract 16045: Buprenorphine and Methadone Treatment is Associated With Less Heart Failure Hospitalizations in Patients With Opioid Use Disorder

Abstract

Introduction: Patients with opioid use disorder (OUD) who receive medication for opioid use disorder (MOUD), either buprenorphine or methadone, have decreased all-cause and overdose mortality. Although in patients with congestive heart failure, OUD is associated with a greater number of heart failure hospitalizations (HFH), no studies were conducted on the outcomes of MOUD in this population. Hypothesis: We hypothesized that in patients with OUD and congestive heart failure, MOUD is associated with a decreased number of HFH. Methods: We retrospectively reviewed records of patients treated at the Rutgers NJMS Ambulatory Care Center, diagnosed with both heart failure and opioid use disorder between 2016 and 2018. We conducted multivariate linear regression to identify predictors of HFH. Results: Among 91 included patients, 60% were male, mean age was 58 ± 7 years old. The majority (75%) of patients were of African American ethnicity. Mean left ventricular ejection fraction (LVEF) was 41 ± 18%; 32% patients had preserved, 22% had mid-range and 46% had reduced LVEF. Over the 2-year period, 57% of patients were treated with buprenorphine, and 76% with methadone - a total of 87% of all patients were on MOUD. Less than half (37%) of the patients had medical insurance. Median number of HFH was 2.0 (IQR 0.0 - 8.5). In multivariate analysis ( table ), number of HFH correlated positively with the presence of insurance (β = 4.02 [95% CI 1.06 to 6.98], p = 0.008) and number of missed appointments (β = 0.33 [95% CI 0.11 to 0.55], p = 0.003), and negatively with MOUD (β = –5.41 [95% CI -9.52 to -1.31], p = 0.01). HFH were not associated with LVEF (p = 0.746), diastolic dysfunction (p = 0.855) or age and gender. Conclusions: In patients with OUD and congestive heart failure, MOUD is independently associated with less HFH and is one of its strongest predictors. Expanding access to methadone and buprenorphine appears to be critical in improving the quality of care of this vulnerable and underserved population.