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Patients with acute cardiovascular conditions who take illegal drugs are nearly nine times more likely to die or experience life-threatening emergencies while in hospital compared to non-users, according to new research.
The study, presented at the ESC Congress 2022 found that multiple drug users had an 11-fold risk of a poor in-hospital prognosis compared with those taking one drug.
Illicit drug use globally has risen 22% in the past decade
With illicit drug use up by 22% globally in the past decade, the researchers set out to discover the prevalence of drug use in intensive cardiac care unit (ICCU) patients and the short-term consequences of taking such drugs.
The Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study assessed the prevalence of illicit drug use and the association with in-hospital major adverse events in consecutive patients admitted for acute cardiovascular events.
During a two-week period in April 2021, all consecutive patients admitted to ICCU in 39 centres throughout France provided a urine sample which was tested for illegal drugs.
Nearly 1,500 patients were screened; 70% were men and the average age was 63 years. Reasons for admission included myocardial infarction, acute heart failure, arrhythmias, myocarditis and pulmonary embolism.
Illicit drug use was common in ICCU patients but under-reported
In total, 161 patients (10.7%) had a positive test for at least one illicit drug. Regarding the types of drugs, 9.1% tested positive for cannabis, 2.1% for opioids, 1.7% for cocaine, 0.7% for amphetamines and 0.6% for MDMA.
All patients completed a questionnaire in which they were asked if they currently used illicit drugs. Of those with a positive urine drug test, just 56.5% reported current use while 43.5% claimed they did not use drugs.
Patients who used illicit drugs tended to be young: one-third (33%) of patients under 40 years of age were users compared with just 6% of those aged 60 years or above. Some 12% of men were users compared to 8% of women.
Cocaine use was associated with a five-fold increase of a major adverse event
During a median hospitalisation of five days, 61 patients (4.1%) had a major adverse event. Illicit drug use was associated with an almost nine-fold increase in major adverse events after adjusting for comorbidities.
After adjustment for age and sex, cannabis use was associated with a three-fold odds of major adverse events while cocaine was associated with a five-fold odds.
Of those using drugs, 28% took more than one type of drug. Multiple drug use was associated with a higher incidence of major adverse events than single drug use, with an odds ratio of 11.4.
Study author Dr. Theo Pezel of Hospital Lariboisiere, Paris, France said the results suggest that patients admitted to the ICCU should be tested for drugs to identify those with an increased likelihood of detrimental outcomes.
He added: “Illicit drug use was common in ICCU patients but under-reported. Users admitted for ST-elevation myocardial infarction (STEMI) and acute heart failure had particularly high risks of death, cardiac arrest or cardiogenic shock with odds ratios of 28.8 and 12.8, respectively.”