Abstract Background Alcohol use disorder (AUD) results in adverse cardiovascular outcomes, including heart failure (HF). Treatment of AUD may modify AU behavior. Pharmacotherapy prescribing prevalence for AU among patients with AU associated HF (AU-HF) is not known. Purpose Evaluate AU treatment prescribing for patients with AU-HF hospitalizations. Methods Data were obtained from the Veterans Affairs corporate data warehouse. We included all patients with a first HF hospitalization from 10-1-15 to 3-30-23. HF, AU and comorbidities were identified using ICD-codes. AU-HF was presumed if AU was identified +/- 1 year of heart failure hospitalization. Prescribed pharmacotherapy for alcohol use (acamprosate, disulfiram, naltrexone and topiramate) was identified using Veterans Affairs pharmacy data. We analyzed prescribing frequency and impact on hospital readmission at 1 year using logistic regression. Odds ratios using models adjusted for age, sex, race and comorbidities are reported with 95% confidence intervals in parentheses. Results Of the 156,910 hospitalizations, 28,111 (18%) were AU-HF and 2234 (8%) were prescribed pharmacotherapy to treat alcohol use; of these 624 (28%) received only one prescription, 431 (19%) received prescription for only 30 days and only 233 (10%) received prescriptions for 1-year. Prescribing was more frequent in younger patients (20% for 25-44 years; 12% for 45-64 years; 5% for 65-84 years and 1% for /=85 years). It did not differ significantly based on sex. Adjusted odds of treatment were lower among Black patients 0.85 (0.77-0.95) Prescribing increased from 6% of AU-HF in 2017 to 9% by 2023 1.1 (1.1-1.2) for each subsequent year. Prescribing was higher for patients with a history of depression 2.5 (2.2-2.8), anxiety 1.6 (1.4-1.7), post-traumatic stress disorder 1.4 (1.3-1.6), hypertension 1.4 (1.2-1.8) and homelessness 1.6 (1.5-1.8); and lower for those with diabetes 0.7 (0.7-0.8), vascular disease 0.7 (0.6-0.8), and chronic kidney disease 0.7 (0.6-0.8). Prescribing was higher for patients followed in outpatient behavior health 4.6 (4.2-5.1) and lower for patient followed in outpatient cardiology 0.9 (0.8-0.9). Prescribing was associated with higher hospital readmission at 1 year 1.1 (1.0-1.2), this was no longer significant after adjustment for outpatient behavioral health follow up 1.1 (0.9-1.2). Conclusion Although prescribing to treat alcohol use remains low among patients with AU-HF, there has been a modest increase over time. Older patients and patients followed in outpatient cardiology have lower odds of prescribing. Prescribing is associated with higher 1-year readmission and may reflect higher overall treatment access and engagement. Access to AUD treatment in medical specialty settings such as cardiology is perhaps an option to increase evidence-based prescribing.
Manja et al. (Sat,) studied this question.