Trends in Substance Use in Patients Requiring Advanced Heart Failure Therapies

Abstract

<h3>Purpose</h3> Determination of psychosocial risk including substance use is a critical factor in candidacy for advanced heart failure therapies. This study aims to evaluate trends in substance use in both acute and end-stage heart failure (ESHF) patients using a large nationwide inpatient database. <h3>Methods</h3> The National Inpatient Sample (NIS) database was queried from 2008 to 2018 to identify adult hospitalizations with a primary diagnosis of cardiogenic shock (CS) or procedure codes for heart transplantation (HT), ventricular assist device (VAD), or temporary mechanical circulatory support (MCS) using International Classification of Disease (ICD)-9 and ICD-10 codes. Active or historic substance use (tobacco; alcohol; opioid; cocaine; cannabis, others) was also abstracted via ICD codes. Multiple logistic regression analysis was performed for yearly trends adjusted for age, sex, and medical co-morbidities using the Charlson Comorbidity Index. Annual percentage change (APC) in odds with the P- <i>trend</i> was calculated. <h3>Results</h3> Results of this study are shown in Table 1. There was a significant increase in tobacco and opioid use among HT hospitalizations over the 10-year study period. CS, temporary MCS, and LVAD hospitalizations demonstrated a significant temporal increase across multiple substance forms, particularly opioid and cannabis use. <h3>Conclusion</h3> In this contemporary cohort of patients, an increasing prevalence of concomitant psychoactive substance use was noted. As ESHF and CS hospitalizations increase, studies are needed to understand outcomes associated with substance use in candidates for advanced therapies.