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
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Article Info
Publication History
Published online: July 29, 2019
Footnotes
☆Funding: The project described was partially supported by the National Institutes of Health (NIH), Grant UL1TR001442 of CTSA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
☆☆Conflicts of Interest: All authors have declared that there are no potential or actual conflicts of interest related to this manuscript.
☆☆☆Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
