Illicit drugs are used by one in ten cardiac intensive care unit patients
Illicit drug use is associated with a nearly nine-fold increased risk of death or life-threatening emergencies in cardiac intensive care unit (CICU) patients, according to research presented at the 2022 ESC Congress.
Study author Dr Theo Pezel from Lariboisiere Hospital, Paris, France, said: “Our study shows that patients with acute cardiovascular conditions who take illegal drugs are more likely to die or experience cardiac arrest or cardiogenic shock while are in the hospital compared to non-users. “Multiple drug users had an 11-fold increased risk of having a poor prognosis in hospital compared to those taking a single drug.”
Illicit drug use has increased by 22% in the last decade to an estimated 275 million people worldwide. In the EU, approximately 83.4 million (29%) people aged 15 to 64 have ever used an illicit drug. Cannabis, cocaine, ecstasy (3,4-methylenedioxymethamphetamine; MDMA), amphetamines and heroin or other opioids are the most commonly used substances. Illicit drugs have been linked to acute cardiovascular events, including heart attacks and aortic dissection, but the prevalence of drug use in CICU patients and the short-term consequences are unknown.
The Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study evaluated the prevalence of illicit drug use and the association with in-hospital major adverse events in consecutive patients admitted for acute cardiovascular events. From April 7 to 22, 2021, all consecutive patients admitted to ICCU in 39 centers across France provided a urine sample that was tested for illegal drugs. The primary outcome was the prevalence of illegal drug use. The secondary outcome was in-hospital major adverse events, defined as death, resuscitated cardiac arrest, or cardiogenic shock.
A total of 1,499 patients were screened , of which 70% were men. The average age was 63 years. Reasons for admission included myocardial infarction, acute heart failure, arrhythmias, myocarditis, and pulmonary embolism. Some 161 patients (10.7%) had a positive test for at least one illicit drug. Regarding drug types, 9.1% tested positive for cannabis, 2.1% for opioids, 1.7% for cocaine, 0.7% for amphetamines and 0.6% for MDMA.
Patients who used illicit drugs tended to be young: one third (33%) of patients under 40 years of age were users compared to only 6% of those over 60 years of age. 12% of men were users compared to 8% of women. All patients completed a questionnaire asking whether they currently used illicit drugs. Of those with a positive urine drug test, only 56.5% reported current use, while 43.5% stated that they did not use drugs.
During a median hospital stay of five days, 61 patients (4.1%) experienced a major adverse event. Illicit drug use was associated with a nearly nine-fold increased odds of major adverse events after adjusting for comorbidities (odds ratio [OR] 8.84, 95% confidence interval [CI] 4.68–16.7; p<0.001). After adjusting for age and sex, cannabis use was associated with a threefold increase in the odds of major adverse events (OR=3.53, 95% CI: 1.25–9.95, p<0.001), while Cocaine was associated with a five-fold higher probability (OR= 5.12; 95% CI 1.48-17.2; p=0.004).
Of those who used 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 (95% CI: 4.31–32.7; p<0.001) .
Dr Pezel said: “Illicit drug use was common in ICCU patients, but was under-reported. Users admitted for ST-segment 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. "Our results suggest that patients admitted to the ICCU should undergo drug screening to identify those with a higher likelihood of harmful outcomes."
