Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego.
Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego; Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California, San Diego.
Am J Med. 2020 Feb;133(2):207-213.e1. doi: 10.1016/j.amjmed.2019.07.017. Epub 2019 Jul 29.
The burden of substance abuse among patients with heart failure and its association with subsequent emergency department visits and hospital admissions are poorly characterized.
We evaluated the medical records of patients with a diagnosis of heart failure treated at the University of California-San Diego from 2005 to 2016. We identified substance abuse via diagnosis codes or urine drug screens. We used Poisson regression to evaluate the incidence rate ratios (IRR) of substance abuse for emergency department visits or hospitalizations with a primary diagnosis of heart failure, adjusted for age, sex, race, medical insurance status, and medical diagnoses.
We identified 11,268 patients with heart failure and 15,909 hospital encounters for heart failure over 49,712 person-years of follow-up. Substance abuse was diagnosed in 15.2% of patients. Disorders such as methamphetamine abuse (prevalence 5.2%, IRR 1.96, 95% confidence interval [CI] 1.85-2.07), opioid use and abuse (8.2%, IRR 1.54, 95% CI 1.47-1.61), and alcohol abuse (4.5%, IRR 1.51, 95% CI 1.42-1.60) were associated with a greater number of hospital encounters for heart failure, with associations that were comparable to diagnoses such as atrial fibrillation (37%, IRR 1.78, 95% CI 1.73-1.84), ischemic heart disease (24%, IRR 1.67, 95% CI 1.62-1.73), and chronic kidney disease (26%, IRR 1.57, 95% CI 1.51-1.62).
Although less prevalent than common medical comorbidities in patients with heart failure, substance-abuse disorders are significant sources of morbidity that are independently associated with emergency department visits and hospitalizations for heart failure. Greater recognition and treatment of substance abuse may improve outcomes among patients with heart failure.
心力衰竭患者的物质滥用负担及其与随后急诊就诊和住院的关系尚未得到充分描述。
我们评估了 2005 年至 2016 年在加利福尼亚大学圣地亚哥分校治疗的心力衰竭患者的病历。我们通过诊断代码或尿液药物筛查来确定物质滥用。我们使用泊松回归来评估物质滥用与心力衰竭主要诊断的急诊就诊或住院的发生率比（IRR），并针对年龄、性别、种族、医疗保险状况和医疗诊断进行了调整。
我们确定了 11268 例心力衰竭患者和 49712 人年随访期间 15909 例心力衰竭住院患者。15.2%的患者被诊断为物质滥用。物质滥用障碍（如甲基苯丙胺滥用（患病率 5.2%，IRR 1.96，95%置信区间[CI] 1.85-2.07）、阿片类药物使用和滥用（8.2%，IRR 1.54，95% CI 1.47-1.61）和酒精滥用（4.5%，IRR 1.51，95% CI 1.42-1.60）与心力衰竭住院次数的增加相关，与心房颤动（37%，IRR 1.78，95% CI 1.73-1.84）、缺血性心脏病（24%，IRR 1.67，95% CI 1.62-1.73）和慢性肾病（26%，IRR 1.57，95% CI 1.51-1.62）等诊断相比，这些关联相当。
尽管心力衰竭患者中物质滥用障碍的患病率低于常见的合并症，但它们是重要的发病源，与心力衰竭的急诊就诊和住院独立相关。对物质滥用的更多认识和治疗可能会改善心力衰竭患者的预后。
