The Impact of Substance Abuse on Heart Failure Hospitalizations

Nishimura, Marin; Bhatia, Harpreet; Ma, Janet; Dickson, Stephen; Alshawabkeh, Laith; Adler, Eric; Maisel, Alan S.; Criqui, Michael H.; Greenberg, Barry; Thomas, Isac C.

doi:10.1016/j.amjmed.2019.07.017

Cited by 50 publications

(48 citation statements)

References 18 publications

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“…Patients hospitalized for CHF with CUD were mostly younger men of African American origin and earned less than the 50th percentile household income. Like our study, it was reported by Nishimura et al that patients hospitalized for heart failure who had a history of substance abuse were mostly males, and likely to be African American and younger [20].…”

Section: Discussionsupporting

confidence: 73%

Congestive Heart Failure Hospitalizations and Cannabis Use Disorder (2010–2014): National Trends and Outcomes

Ajibawo

Ajibawo-Aganbi

Jean-Louis

et al. 2020

Cureus

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Background and objectives: Prior studies have suggested that cannabis use is an independent risk factor for heart failure. With increasing recreational use of cannabis and decriminalization policies, cannabis use is expected to add to the burden of heart failure, but there is still limited data. Therefore, we utilized the Nationwide Inpatient Sample (NIS) database (2010-2014) to study the national trends and outcomes among cannabis users admitted for congestive heart failure (CHF). Methods: We queried the NIS database and identified CHF as the primary diagnosis with a codiagnosis of cannabis use disorder (CUD). Trends were analyzed with the linear-by-linear association. Results: Total CHF admissions (N = 4,596,024) with comorbid CUD (N = 23,358 (0.5%)) were identified. An increasing prevalence trend from 0.4% to 0.7% (P= 0.001) was seen. CUD patients had a mean age of 49.78 years, 79% were males, 55.4% were African Americans, and 73.6% earn ≤ 50th percentile median household income of the patient's ZIP code. Inpatient deaths (1.1% vs. 3.1%) were lower (P<0.001), and mean length of stay (LOS) was shorter among cannabis users compared to non-users (P=0.001). The mean LOS and total hospitalization costs demonstrated an increasing trend (P trend = 0.001 and P trend < 0.001) respectively. Alcohol abuse and depression were more prevalent among CUD compared to non-CUD patients. Conclusion: CUD was associated with reduced inpatient deaths, but the prevalence of CUD and hospital charges is on the rise in the CHF inpatient population in addition to shorter mean LOS. Notwithstanding, these above findings prompt further research into its underlying mechanisms along with a probable causal relationship between cannabis and heart failure.

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Section: Discussionsupporting

confidence: 73%

Congestive Heart Failure Hospitalizations and Cannabis Use Disorder (2010–2014): National Trends and Outcomes

Ajibawo

Ajibawo-Aganbi

Jean-Louis

et al. 2020

Cureus

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“…For example, social and economic despair may contribute to both (12,16). Opioid use is a risk factor for heart disease (17), and a portion of CVD deaths may be attributable to opioid use (18).…”

Section: Discussionmentioning

confidence: 99%

US life expectancy stalls due to cardiovascular disease, not drug deaths

Mehta

Abrams

Myrskylä

2020

Proc. Natl. Acad. Sci. U.S.A.

138

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After decades of robust growth, the rise in US life expectancy stalled after 2010. Explanations for the stall have focused on rising drug-related deaths. Here we show that a stagnating decline in cardiovascular disease (CVD) mortality was the main culprit, outpacing and overshadowing the effects of all other causes of death. The CVD stagnation held back the increase of US life expectancy at age 25 y by 1.14 y in women and men, between 2010 and 2017. Rising drug-related deaths had a much smaller effect: 0.1 y in women and 0.4 y in men. Comparisons with other high-income countries reveal that the US CVD stagnation is unusually strong, contributing to a stark mortality divergence between the US and peer nations. Without the aid of CVD mortality declines, future US life expectancy gains must come from other causes-a monumental task given the enormity of earlier declines in CVD death rates. Reversal of the drug overdose epidemic will be beneficial, but insufficient for achieving pre-2010 pace of life expectancy growth.life expectancy | mortality | cardiovascular disease | drug-related mortality | opioid epidemic L ife expectancy in the United States increased at a phenomenal pace throughout the twentieth century, by nearly 2 y per decade (1). A major driver of the improvement after 1970 was the decline in cardiovascular disease (CVD) mortality. This "CVD revolution" has been attributed to improved pharmacological management, advances in surgical techniques, and healthier lifestyles (2). US death rates from CVD halved between 1970 and 2002 (3).After 2010, however, US life expectancy growth stalled and has most recently been declining. A critical question for American health policy is how to return US life expectancy to its pre-2010 growth rate. While much attention is being directed at drug-related deaths (4-6), we demonstrate that the changing trajectory of CVD deaths has been the most consequential cause-specific trend for the post-2010 US life expectancy stall. This link has not been empirically demonstrated, in part, because past analyses have focused on the very recent period in which CVD mortality had already stalled. For example, Ho and Hendi (5) was concerned with the year-over-year life expectancy decline that occurred during 2014-2015, and concluded that the US decline was mainly attributable to drug-related mortality; and Barbieri (4) focused on drug-related mortality in an analysis of causes of deaths that have contributed to the US shortfall in life expectancy relative to 12 other high-income countries in 2014. Consistent with our findings, Barbieri (4) found that drug-related mortality accounted for only about 10% of the US shortfall in 2014, and concluded, "Overall, the largest [reduction in the US life expectancy shortfall] would be achieved by reducing the US disadvantage in mortality not from drug use, alcohol and chronic liver diseases or suicide, but from other broad cause-of-death categories." In this paper, we show that CVD is the key cause-of-death category for understanding the US life expectanc...

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“…We used International Classification of Diseases , Ninth Revision , Clinical Modification , (ICD-9-CM) and (ICD-10-CM) diagnosis codes to identify heart failure patients who were 18 years or older ( S1 Table ) [ 6 ]. We then utilized ICD-9-CM codes and ICD-10-CM codes previously validated in the psychiatry and cardiology literature to identify patients with cannabis use disorder and opioid use disorder ( S1 Table ) [ 4 , 7 , 8 ]. Patients with coding for CUD or OUD remission were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Despite the growing prevalence of these diseases, little research has investigated their existence and effects among patients admitted for heart failure (HF). Institutional data has found that a significant proportion of HF patients suffer from CUD and OUD and that OUD is associated with an increased HF incidence rate [ 4 ]. However, there has been no investigation of the prevalence and effects of CUD and OUD in HF using generalizable data.…”

Section: Introductionmentioning

confidence: 99%

Brief report: Cannabis and opioid use disorder among heart failure admissions, 2008–2018

et al. 2021

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Background In the United States, both cannabis use disorder (CUD) and opioid use disorder (OUD) have increased in prevalence. The prevalence, demographics, and costs of CUD and OUD are not well known in heart failure (HF) admissions. This study aimed to use a national database to examine the prevalence, demographics, and costs associated with CUD and OUD in HF. Methods This study used the National Inpatient Sample from 2008 to 2018 to identify all primary HF admissions with and without the co-diagnosis of OUD or CUD using International Classification for Diagnosis, diagnosis codes. Demographics, costs, and trends were examined. Results Between 2008 and 2018, we identified 11,692,995 admissions for HF of which 84,796 (0.8%) had a co-diagnosis of CUD only, and 67,137 (0.6%) had a co-diagnosis of OUD only. The proportion of HF admissions with CUD significantly increased from 0.3% in 2008 to 1.3% in 2018 (p<0.001). The proportion of HF admissions with OUD significantly increased from 0.2% in 2008 to 1.1% in 2018 (p<0.001). Patients admitted with HF and either CUD or OUD were younger, more likely to be Black, and from lower socioeconomic backgrounds (p<0.001, all). HF admissions with OUD or CUD had higher median costs compared to HF admissions without associated substance abuse diagnoses ($8,611 vs. $8,337 for CUD HF and $10,019 vs. $8,337 for OUD HF, p<0.001 for both). Conclusions Among discharge records for HF, CUD and OUD are increasing in prevalence, significantly affect underserved populations and are associated with higher costs of stay. Future research is essential to better delineate the cause of these increased costs and create interventions, particularly in underserved populations.

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The Impact of Substance Abuse on Heart Failure Hospitalizations

Cited by 50 publications

References 18 publications

Congestive Heart Failure Hospitalizations and Cannabis Use Disorder (2010–2014): National Trends and Outcomes

Congestive Heart Failure Hospitalizations and Cannabis Use Disorder (2010–2014): National Trends and Outcomes

US life expectancy stalls due to cardiovascular disease, not drug deaths

Brief report: Cannabis and opioid use disorder among heart failure admissions, 2008–2018

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