One in 10 patients in cardiac ICU uses recreational drugs; half fail to disclose it
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Key takeaways:
- Recreational drug use was detected among 11% of patients admitted to cardiac ICUs.
- Cannabis, cocaine and MDMA were independently associated with increased odds for major in-hospital events.
Use of recreational drugs such as cannabis, opioids, cocaine and amphetamines was prevalent in 11% of patients admitted to French cardiac ICUs and tied to increased odds of in-hospital major adverse events, researchers reported.
The findings of the Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study were published in Heart.
Image: Adobe Stock
“To our knowledge, this study is the first to measure the prevalence of recreational drugs using a systematic urine drug assay in all consecutive patients admitted to intensive cardiac care units. The use of a systematic urine assay also allows a real quantification of the risk of under-declaration of drug consumption, with almost half of drug-using patients not declaring this consumption,” Théo Pezel, MD, PhD, FESC, cardiologist at Hôpital Lariboisière in Paris, and colleagues wrote. “This study is also the first to describe an independent prognostic impact of recreational drugs on the occurrence of intra-hospital outcomes in patients with an acute cardiovascular event.”
Recreational drug use in patients in the cardiac ICU
The ADDICT-ICCU study included 1,499 consecutive patients (mean age, 63 years; 70% men) admitted to the cardiac ICU who underwent systematic screening for recreational drugs at 39 French centers from April 7 to April 22, 2021.
The primary outcome was the prevalence of recreational drug use.
The most common reasons for cardiac ICU admission were STEMI, followed by non-STEMI, acute HF, arrhythmia, myocarditis, pericarditis, cardiac conduction abnormalities and pulmonary embolism. Patients admitted for scheduled elective interventions were omitted for this analysis.
Overall, 11% of patients admitted to the cardiac ICU had a positive test for recreational drugs:
- 9.1% for cannabis;
- 2.1% for opioids;
- 1.7% for cocaine;
- 0.7% for amphetamines; and
- 0.6% for 3,4-methylened ioxymethamphetamine (MDMA).
Among those with urinary screening-confirmed drug use, 57% of patients declared their use.
After adjustment for comorbidities, patients with recreational drug use experienced greater odds for in-hospital major adverse events — defined as death, resuscitated cardiac arrest or hemodynamic shock — compared with nonusers (OR = 8.84; 95% CI, 4.68-16.7; P < .001).
Multiple recreational drugs were simultaneously detected in 28% of patients with recreational drug use. This was associated with even greater odds of in-hospital major adverse events (OR = 12.7; 95% CI, 4.8-35.6; P < .001), according to the study.
After adjustment, the researchers reported that cannabis (OR = 3.53; 95% CI, 1.25-9.95; P < .001), cocaine (OR = 5.12; 95% CI, 1.48-17.2; P = .004) and MDMA (OR = 29.3; 95% CI, 7.77 to > 100; P < .001) were each independently associated with elevated likelihood for in-hospital major adverse events.
“Recreational drugs are detected in more than one out of 10 consecutive patients admitted to an intensive cardiac care unit, with a risk of underreporting by about one in two patients,” the researchers wrote. “The detection of recreational drug use is independently associated with the occurrence of in-hospital outcomes. Public health strategies aimed at offering systematic screening for recreational drugs on admission to intensive care unit could lead to improvement in patient prognosis by allowing optimal management.”
Pros and cons of routine drug screening
In a related editorial, Fizzah A. Choudry, PhD, consultant in coronary intervention at Barts Heart Centre in London, and colleagues discussed the advantages and disadvantages of routine drug screening in this population.
“Knowledge that recreational drugs may be contributing to abnormal hemodynamics, or noncardiac issues ... may influence management in individual cases,” the authors wrote. “A positive test result would provide an opportunity for counseling about the adverse medical, psychological and social effects of drugs, and for the implementation of interventions aimed at the cessation of drug use.
“This study, however, has not provided evidence which justifies screening for recreational drug use,” they wrote. “No data were presented concerning the cost of screening, the benefits arising from screening or its cost-effectiveness. Furthermore, screening for recreational drug use raises important questions concerning patient confidentiality and the potential for discrimination in how targeted screening might be applied.”
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