Recreational Drug Use Linked to 9-Fold Higher Rate of Adverse Outcomes in Intensive Cardiac Care

New research detected recreational drug use in more than 1 in 10 patients admitted to cardiac intensive care units across France, indicating drug use as a robust independent predictor of in-hospital major adverse events (MAEs).¹

The analysis of the Addiction In Intensive Cardiac Care Units (ADDICT-ICCU) study showed recreational drug users were approximately 9 times as likely to die or require emergency interventions compared with other hospitalized patients and 12 times more likely if they used more than one drug. Findings were published in the BMJ journal Heart.

“Using a systematic urine assay, our study is the first to suggest a poorer in-hospital prognosis in those with detected recreational drugs in all consecutive patients admitted to ICCUs, which shows a potential interest in improving risk stratification of these patients,” wrote the investigative team, led by Professor Patrick Henry, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, Université Paris Cité.

Data suggest an estimated 275 million people globally used recreational drugs in 2022, a 22% increase in the figure since 2010. Cannabis, cocaine, 3,4-methylenedioxymethamphetamine (MDMA), amphetamines, heroin, and other opioids were among the agents found most commonly used.

The chronic recreational use of these substances is a risk factor for various acute cardiovascular (CV) events, including sudden cardiac death, acute heart failure, thromboembolic events, and cardiac arrhythmia, the authors wrote. There is evidence that substance use by patients with myocardial infarction is associated with worse outcomes over time, but these studies were often retrospective or post hoc analyses without systematic screening and with a risk of recall bias, added Henry et al.

Current guidelines recommend only a declarative survey to investigate recreational drug use and not a systematic urine or plasma screening. As a result, the prevalence of drug use in patients hospitalized in ICCUs and their effect on short-term CV outcomes is still unknown.

ADDICT-ICCU was designed to prospectively assess the prevalence of recreational drug use and its association with the occurrence of in-hospital MAEs. The observational study analyzed urine samples of all consecutive patients aged ≥18 years admitted to ICCUs across a 2-week period in April 2021 in France.

For the analysis, clinical outcomes included in-hospital MAEs defined as in-hospital death, resuscitated cardiac arrest, and hemodynamic shock requiring medical or mechanical hemodynamic support.

Within the study period, a total of 1904 patients were admitted to ICCUs in the 39 participating centers. After applying exclusion criteria, 1499 patients (95.2%) were screened using a urine drug assay (mean age, 63 years; 70% men).

FINDINGS

Of the 1499 screened patients, 161 (11%) had a positive urine test for ≥1 recreational drug, including cannabis (9.1%), opioids (2.1%), cocaine (1.7%), amphetamines (0.7%), and MDMA (0.6%). A total of 116 (72.0%) patients had used a single drug and 45 (28.0%) had used multiple recreational drugs. However, of the recreational drug users, only 91 (57%) declared recreational drug use during the admission interview by physicians.

During hospitalization, there were 61 in-hospital MAEs (4.3%), including 25 (1.8%) in-hospital deaths, 10 (0.7%) cardiac arrests, and 26 (1.8%) hemodynamic shocks requiring hemodynamic support.

In multivariable analysis, the detection of recreational drug use was independently associated with in-hospital MAEs after adjusting for comorbidities (odds ratio [OR], 8.84; 95% CI, 4.68 - 16.7; P<.001). Compared with non drug-using heart patients, those who used recreational drugs showed a higher MAE rate, including hemodynamic shock and cardiac arrest, while in the hospital (13% vs. 3%; P<.001).

Further analyses revealed cannabis (P<.001), cocaine (P=.004), and MDMA (P <.001), assessed separately, were significantly associated with in-hospital MAEs. The detection of multiple recreational drugs was associated with a higher rate of in-hospital MAEs (OR, 12.7; 95% CI, 4.80 - 35.6; P<.001), compared with a single drug (OR, 6.31; 95% CI, 3.01 - 12.8; P<.001).

Investigators urged caution in clinical interpretation of the findings, citing the limited number of events and short study period among the study's limitations.

“Although the strong associations between the use of recreational drugs and the occurrence of MAEs suggest an important prognostic role, the limited number of events requires caution in the clinical interpretation of these findings,” investigators said in a BMJ press statement.²

This article originally appeared on our partner site, HCPLive and has been lightly edited.

References

1. Pezel T, Dillinger J, Trimaille A, et al. Prevalence and impact of recreational drug use in patients with acute cardiovascular events. Heart. Published online August 15, 2023. doi: 10.1136/heartjnl-2023-322520
2. Recreational drugs found in more than 1 in 10 cardiac intensive care patients. BMJ. News release. Accessed August 16, 2023. https://www.bmj.com/company/newsroom/recreational-drugs-detected-in-more-than-1-in-10-cardiac-intensive-care-patients/