2023-08-16 23:05:15
LONDON, August 16, 2023 (APMnews) – Recreational drug use has been found in more than 1 in 10 patients hospitalized in the cardiology intensive care unit and is associated with an increased risk of death or emergency intervention, according to a French study published Tuesday in Heart.
Epidemiological studies have shown that the recreational use of illicit substances can cause acute cardiovascular events, with in particular recent consumption of cocaine or cannabis found in patients who have had a myocardial infarction. But these studies are often retrospective, carried out in young patients, declarative, without systematic screening, recall Théo Pezel of U942 Inserm / University Paris Cité at the Lariboisière hospital in Paris (AP-HP) and his colleagues.
They wanted to determine the prevalence of this recreational drug use among patients cared for in cardiology intensive care units (Usic) and assess its association with adverse events during hospitalization.
For this, they conducted an observational, prospective and multicenter study with all adult patients admitted consecutively over two weeks in 39 Usic distributed over all French regions.
Among the reasons for admission of the 1,499 patients (63 years on average, 70% men) included were acute coronary syndrome (50.8%), acute heart failure (13.5%), severe cardiac conduction (5.5%), arrhythmia (6.5%), pulmonary embolism (3.1%), myocarditis or pericarditis (4.7%), tako-tsubo syndrome (1.1 %)… 6.3% of patients presented with chest pain without an identified cardiovascular cause.
They were 10.7% to present at least one positive result to an illicit substance in the urine screening: 9.1% to cannabis, 2.1% to an opioid, 1.7% to cocaine, 0.7% to a amphetamine and 0.6% MDMA. But only just over half (56.5%) of these patients admitted to having used a drug when questioned.
The majority of patients with a positive drug test had only used one (72%), recreational use concerned more men (11.9% vs 8.1%), younger people (53, 1 year on average vs 64.6 years) and more smokers (56.3% vs 21.8%).
In the entire cohort, more than a third of patients had known coronary artery disease and 5.2% known cardiomyopathy. But some comorbidities were less common among those with a positive drug test, such as diabetes (13.3% vs 22.7%), high blood pressure (32.3% vs 56.5%) or dyslipidemia (28. 5% vs. 39.9%).
The potential effect of recreational drug use on patient outcomes during hospitalization was assessed in 1,411 patients. Data analysis, adjusted for potential confounders (known comorbidities and predictors), recreational drug use was statistically significantly associated with major adverse events during hospitalization, with a close relative risk (OR) of 8.1 compared to no recreational use.
For each major adverse event component, recreational drug use was associated in particular with an OR of 5.2 for hemodynamic shock and 33.4 for resuscitated cardiac arrest. On the other hand, the association with intra-hospital death was not significant.
The researchers confirmed this association between recreational drug use and major adverse events during hospitalization in a propensity score matching analysis.
Other analyzes indicate that separately assessed recreational use of cannabis, cocaine or MDMA was significantly associated with the occurrence of major adverse events during hospitalization and that the effect of recreational use was greater with multiple drug intake than with a single one.
To the knowledge of the authors, this study is the first to measure the prevalence of drugs used recreationally by systematic urine assay among all patients admitted consecutively to Usic and to describe the prognostic impact of this recreational use on the evolution of patients hospitalized for an acute cardiovascular event.
These results suggest that systematic screening for illicit substances on admission to intensive care might make it possible to adapt care and improve the prognosis of the patients concerned, they comment.
In an associated editorial, Fizzah Choudry and colleagues at St Bartholomew’s Hospital in London welcome this work but believe that the causal relationship between recreational drug use and the cardiovascular event prompting hospitalization is unclear, as is not the case. is not the context of drug use. They consider it important that further studies be carried out on this subject before being able to recommend systematic drug screening.
(Heart, August 15 online publication et associated editorial)
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