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Patients in critical cardiac care units are found to utilise illicit substances: Study

by Pragati Singh

In patients in the intensive cardiac care unit (ICCU), illicit substance usage is associated with a roughly nine-fold greater risk of mortality or life-threatening events.

At the ESC Congress 2022, the research was presented. Dr. Theo Pezel, the study’s author from the Hospital Lariboisiere in Paris, France, said: “Our research demonstrates that compared to non-users, patients with acute cardiovascular conditions who use illegal drugs are more likely to pass away, go into cardiac arrest, or experience cardiogenic shock while hospitalised. Compared to people who only take one medication, people who use many drugs have an 11-fold increased chance of having a bad in-hospital prognosis.”

2 In the EU, 83.4 million people between the ages of 15 and 64 (about 29%) have ever taken an illegal substance. 3 The most widely used drugs include marijuana, cocaine, ecstasy (3,4-methylenedioxymethamphetamine; MDMA), amphetamines, and heroin or other opioids. Illegal drug use has been associated with acute cardiovascular events, such as heart attacks and aortic dissections4,5, but it is unknown how common drug use is among ICCU patients and what the immediate effects are.

In a series of patients treated for acute cardiovascular events, the Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) research examined the incidence of illegal drug use and its correlation with in-hospital significant adverse events. All consecutive patients admitted to the ICCU in 39 facilities across France from April 7 to April 22 supplied a urine sample for testing for illicit medications.

The prevalence of using illicit drugs was the main result. The secondary outcome was in-hospital serious adverse events, which were defined as death, cardiogenic shock, or resuscitated cardiac arrest.

70 percent of the 1,499 patients who underwent screening were males. It was 63 years old on average. Myocardial infarction, abrupt heart failure, arrhythmias, myocarditis, and pulmonary embolism were among the causes for hospitalisation. A total of 161 patients (10.7%) had at least one illegal substance test come back positive. 9.1% of people tested positive for marijuana, 2.1% for opiates, 1.7% for cocaine, 0.7% for amphetamines, and 0.6% for MDMA, among other substances.

Patients who used illegal drugs tended to be young: just 6% of patients 60 years of age or more and 33% of patients under the age of 40 reported using illicit drugs. 12% of males and 8% of women reported using drugs. Every patient filled out a form that included a question about current drug usage. Only 56.5% of individuals with a positive urine drug test admitted to using drugs currently, whereas 43.5% insisted they did not.

61 patients (4.1%), who spent a median of five days in the hospital, experienced a significant adverse event. After comorbidities were taken into account, illicit drug use was linked to risks of major adverse outcomes that were nearly nine times higher (odds ratio [OR] 8.84? 95% confidence interval [CI] 4.68-16.7; p0.001).

Cannabis use was linked to a three-fold increased risk of major adverse events (OR=3.53? 95% CI 1.25-9.95; p=0.001), whereas cocaine use was linked to a five-fold increased risk (OR=5.12? 95% CI 1.48-17.2; p=0.004) after adjusting for age and sex.

28% of drug users used more than one kind of substance. A greater frequency of serious adverse events was linked to multiple drug use than to single drug use, with an odds ratio of 11.4 (95% CI 4.31-32.7; p0.001).

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Illegal drug use was widespread yet underreported among ICCU patients, according to Dr. Pezel. With odds ratios of 28.8 and 12.8, respectively, users hospitalised for ST-elevation myocardial infarction (STEMI) and acute heart failure had disproportionately high probabilities of passing away, experiencing cardiac arrest, or experiencing cardiogenic shock.

Our findings imply that patients admitted to the ICCU should undergo drug testing in order to identify individuals who are more likely to experience negative outcomes.

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