Daily Dose: Recreational Drug Use in Patients with Acute CV Events

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on a study published in the BMJ journal Heart.

The study

An analysis of the Addiction In Intensive Cardiac Care Units (ADDICT-ICCU) study, which was designed to prospectively assess the prevalence of recreational drug use and its association with the occurrence of in-hospital major adverse events (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).

The 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%).

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).

Authors' commentary

“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."

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