Prevalence of substance use disorder among patients hospitalized for heart failure

Background Substance use disorder (SUD) results in adverse cardiovascular outcomes, including heart failure (HF). Identifying prevalence of SUD among HF hospitalizations is necessary to address SUD related harms. Purpose Characterize the prevalence of SUD in HF hospitalizations in an integrated healthcare system. Methods Data were obtained from the Veterans Affairs corporate data warehouse and included all patients with a first HF hospitalization from 10-1-15 to 3-30-23. HF, SUDs, and comorbidities were identified using ICD-codes. SUD-associated HF (SUD-HF) was presumed if SUD was identified +/- 1 year of HF hospitalization. We analyzed the annual prevalence of SUD , geographic variation, HF category [preserved (HfpEF) or reduced (HFrEF) ejection fraction], and hospital readmission and emergency room visits during 1-year after hospital discharge. Odds ratios using logistic regression models adjusted for age, sex, race, and comorbidities are reported in parentheses. Results Of the 157,316 patients with HF hospitalizations surviving initial hospitalization 24.3% had an associated SUD. Alcohol UD was most prevalent (18%) followed by opioid UD (7%), cocaine UD (5%) and methamphetamine UD (3%). Average age was 72 years. Women (67 versus 72 years for men, p<0.001) and Black veterans (68 versus 73 years for white, p<0.001) were younger. Average age in years for patients with SUD {methamphetamine(62), cocaine(63) alcohol(67), opioid(68)] was lower versus no SUD(74) (Fig 2a; all p<0.001). Association with methamphetamine UD increased from 2% of hospitalizations in FY 17 to 4% in FY 22, all other SUD prevalence stayed stable over time (Fig2b). Significant geographic variation in SUD prevalence was noted (Figure 1, p<0.001). Prevalence among men and women were similar except for higher alcohol UD prevalence in men (18% versus 13%; OR 2.1; 1.9-2.2). Black patients had a higher prevalence of cocaine UD (15% versus 5% overall, OR 6.8; 6.4-7.1) and alcohol UD (25% versus 18% overall, OR 1.4; 1.4-1.5). SUD-HF was associated with higher prevalence of HFrEF and lower prevalence of HFpEF compared to No SUD (Fig 2c). 1-year hospital readmission were higher with SUD (1.4; 1.2 – 1.5), in Black patients (OR 1.2; 1.1 – 1.3), with HFrEF (1.3; 1.2 – 1.4) and with cardiovascular and mental health comorbidities. emergency room visits were higher with SUD (1.2; 1.1-1.3; Fig 2d), in Black patients (1.2; 1.1 – 1.3) and with cardiovascular and mental health comorbidities. Conclusion Nearly 1 in 4 patients hospitalized with heart failure have a SUD with age, sex and race related differences. Patients with associated SUD are younger, more likely to have HFrEF, and have higher unplanned hospital readmission and emergency room visits in 1-year after hospital discharge. Hospitalists need to be attentive to the possibility of co-morbid SUD. Starting SUD treatment before hospital discharge maybe an opportunity to increase evidence based treatment.Geographic Variation in SUD in HF Comparison between SUD versus no SUD