Key result
Chronic opioid use in hospitalized HFpEF patients did not affect all-cause in-hospital mortality compared to nonusers.
Why the study?
Opioid misuse affects diverse populations including those with heart failure, and because HFpEF accounts for nearly half of all heart failure cases, evaluating the outcomes of chronic opioid therapy in this group is needed.
Does chronic opioid therapy affect all-cause in-hospital mortality and adverse in-hospital outcomes in hospitalized patients with heart failure with preserved ejection fraction (HFpEF)?
Cohort (n=1,557,344)
Yes
Does chronic opioid therapy affect all-cause in-hospital mortality and adverse in-hospital outcomes in hospitalized patients with heart failure with preserved ejection fraction (HFpEF)?
In hospitalized patients with HFpEF, chronic opioid therapy is not associated with increased in-hospital mortality, but is linked to significantly higher risks of acute kidney injury/hemodialysis, mechanical ventilation, and longer hospital stays.
Answers are grounded in this paper and cite their sources.
Chronic opioid use warrants no mortality-based restriction in HFpEF; leaves open associations with AKI, ventilation, and length of stay.
BACKGROUND: Opioid misuse has become a widespread public health issue, affecting diverse patient populations, including those with heart failure. Given that heart failure with preserved ejection fraction (HFpEF) constitutes nearly half of all heart failure cases, understanding its management and the influence of various factors on patient outcomes is essential. This study seeks to evaluate the outcomes of chronic opioid therapy in patients with HFpEF. METHODS: Utilizing the National Inpatient Sample (2016-2020), adult HFpEF patients were identified using the appropriate International Classification of Diseases, Tenth Revision codes, excluding those with end-stage renal disease. Outcomes were compared between chronic opioid users and nonusers. Multivariate logistic and linear regression analyses were conducted, controlling for various patient and hospital confounders. The primary outcome measured was all-cause in-hospital mortality, with secondary outcomes including acute kidney injury/hemodialysis (AKI/HD), cardiogenic shock, cardiac arrest, mechanical ventilation, length of stay, and total hospital charges. RESULTS: Among 1,557,344 HFpEF patients, 21,655 (1.4 percent) were on chronic opioid therapy. No significant difference in inpatient mortality was found (adjusted odds ratio [aOR] 1.04, 95 percent confidence interval [CI]: 0.88-1.24, p = 0.58). A nonsignificant increase in cardiogenic shock (aOR 1.12, 95 percent CI: 0.85-1.48, p = 0.39) and cardiac arrest (aOR 1.06, 95 percent CI: 0.81-1.38, p = 0.65) was noted in chronic opioid users. However, chronic opioid use was associated with a higher risk of AKI/HD (aOR 1.15, 95 percent CI: 1.07-1.24, p < 0.001) and mechanical ventilation (aOR 1.27, 95 percent CI: 1.14-1.41, p < 0.001). Opioid use was also linked to longer hospital stays (adjusted mean difference [aMD] 1.15 days, 95 percent CI: 0.83-1.47, p < 0.001) and a nonsignificant increase in total charges (aMD USD 3,615, 95 percent CI: USD -1.014 to USD 8,245, p = 0.12). CONCLUSIONS: While chronic opioid use in hospitalized HFpEF patients did not significantly affect in-hospital mortality, it was associated with a higher risk of other adverse events and longer hospital stays.
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Younes et al. (2026) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=1,557,344). Chronic opioid therapy vs. Nonusers of chronic opioids was evaluated on All-cause in-hospital mortality (aOR 1.04, 95% CI 0.88-1.24, p=0.58). Chronic opioid use in hospitalized HFpEF patients did not affect all-cause in-hospital mortality compared to nonusers.
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