The Effect of Alcohol Abuse and Tobacco Use in the Development of Early Onset Acute Heart Failure Syndrome

Abstract

Introduction. Alcohol abuse is a major cause of cardiomyopathy, subsequently leading to heart failure. Aim. To evaluate the incidence of acute heart failure syndrome (AHFS) among patients with alcohol abuse/dependence, and to evaluate the synergistic effect of tobacco use among the same group of patients. Methods: A retrospective analysis was performed on 2,005 patients admitted to our hospital for an acute heart failure syndrome (AHFS) from January 1, 2005 to December 31, 2015. A history of alcohol abuse/dependence was defined as a documentation of alcohol abuse for more than 2 years, or if patients were evaluated at chemical dependency clinic for alcohol abuse. Tobacco use was defined as a documented history of at least 2 years of smoking regardless of the amount of cigarettes consumed. Heart failure with reduced ejection fraction (HFrEF) was defined as having LVEF ≤40%, while heart failure with preserved ejection fraction (HFpEF) was defined as having LVEF >40%. The average age when the first episode of AHFS occurred was calculated. Results: The mean age of our 2,005 AHFS patient population was 69 (Standard deviation 68.2–69.8). Of 2,005 patients admitted for AHFS, 94 patients (4.7%) were found to have a history of alcohol abuse/dependence. Patients with a history of alcohol abuse/dependence appear to develop AHFS about 12 years earlier than non-alcohol abuse patients (P < .001). When tobacco use was incorporated as a risk factor, those with both alcohol abuse and tobacco use seemed to develop AHFS about 10 years earlier than those with a history of either alone (P < .001), and about 16 years earlier when compared to those with neither alcohol abuse nor tobacco use (P < .001). Patients with a history of alcohol abuse were likely to have HFrEF (68.1%) compared to 51.7% in non-alcohol abuse patients (OR: 2, 95% CI: 1.3–3, P < .001). During subgroup analysis, the average age of AHFS in the HFrEF-alcohol abuse group was 56.4 years versus 66.5 years in the HFrEF-non-alcoholic group (P < .001) while the average age in HFpEF-alcoholic group was 61.5 years versus 73 years in HFpEF-non-alcoholic group (P < .0001). Conclusions: The average age of onset of AHFS in patients with alcohol abuse/dependence was significantly lower than in those without alcohol abuse/dependence. Furthermore, patients with alcohol abuse who consumed tobacco developed AHFS at an even earlier age when compared to those with either alcohol abuse/dependence or tobacco use alone, suggesting a possible synergistic effect between these two risk factors in developing early-onset AHFS.