TOP4: Measuring patient alcohol intake pre and post-LVAD implant – what’s in a number?

Abstract

Background: Our center routinely screens advanced heart failure patients for unhealthy alcohol use as part of their initial evaluation. One assessment tool utilized is the phosphatidylethanol (PEth) blood concentrations in the blood. PEth is a biomarker that measures the presence of ethanol with a half-life of 4-10 days and a window of detection of 2-4 weeks. The detection window can be longer in patients with excessive alcohol intake. Based on literature reviews, PEth values can be classified as: Light or no Consumption (<20 ng/mL), Significant Consumption (20–199 ng/mL), or Heavy Consumption (>200 ng/mL). Utilizing the PEth testing, we sought to determine: did preop PEth level correlate with alcohol consumption reported during evaluation; did PEth level increase immediately after implant due to blood transfusions and did random PEth screenings six months after implant correlate with preop values and patient reported alcohol intake. The literature suggests that alcohol consumption increases risk of GI bleeds which contributes to patient morbidity while on left ventricular assist device (LVAD) therapy. We sought to determine if elevated PEth levels in patients post-implant were associated with any bleeding after implant. Method: PEth levels were collected in 16 Heartmate 3 LVAD patients within 24 hours of LVAD implant, three business days after LVAD implant and 90 days after LVAD implant. Test was determined to be negative when PEth value was <20ng/ml. The study period was from March 2022 – October 2022. Results: Of the 16 patients, only 2 had positive PEth screening pre-implant for durable VAD. The 2 patients who were positive pre-implant had confirmed alcohol use during their pre-implant psychosocial assessment. Interestingly, 1 patient had positive PEth 3 days post implant and associated subarachnoid hemorrhage and surgical bleeding. This patient PEth level pre-implant was negative and he was hospitalized the entire pre-operative period suggesting that the blood he received at implant may have been the cause of this positive PEth. Of the 16 patients, a total of 6 were identified as having any bleeding post-operatively and none of those six patients had a positive PEth pre-implant. Conclusion: PEth levels are helpful in assessing alcohol intake in our LVAD patients pre/post-implant. PEth provides clinicians with an objective measurement for further discussions with patients about their alcohol intake and how alcohol use can have negative impacts on survival post-VAD. There is little evidence from our small study to suggest that blood transfusions can cause elevated PEth levels. Our data suggests PEth can provide clinicians with an objective measurement to assess patient alcohol intake. PEth assists the clinical team in addressing the amount of alcohol consumption as PEth values >20ng/ml are associated with moderate consumption and >200ng/dl indicate heavy drinking patterns. Further studies are needed for validation.