Association of opioid use disorder with outcomes of hospitalizations for acute myocardial infarction in the United States

Ascandar, Nameer; Vadlakonda, Amulya; Verma, Arjun; Chervu, Nikhil; Roberts, Jacob S.; Sakowitz, Sara; Williamson, Catherine; Benharash, Peyman

doi:10.1016/j.clinsp.2023.100251

Nameer Ascandar

Conceptualization

Methodology

Data analysis

Writing - Original Draft

Generating Figures/Tables

Reviewing

Editing

1 The authors contributed equally to the work presented in the manuscript

Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

http://orcid.org/0000-0003-0304-1580

Amulya Vadlakonda

Conceptualization

Methodology

Data analysis

Writing - Original Draft

Generating Figures/Tables

Reviewing

Editing

1 The authors contributed equally to the work presented in the manuscript

Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

http://orcid.org/0000-0003-3778-1966

Arjun Verma

Validation

Methodology

Reviewing

Editing

Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

http://orcid.org/0000-0003-3561-0960

Nikhil Chervu

Reviewing

Editing

Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

http://orcid.org/0000-0003-0327-9847

Jacob S. Roberts

Writing

Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

http://orcid.org/0000-0002-2406-2500

Sara Sakowitz

Reviewing

Editing

Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

http://orcid.org/0009-0004-7318-7571

Catherine Williamson

Reviewing

Editing

Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

http://orcid.org/0000-0002-3485-8801

Peyman Benharash ^⁎* Corresponding author. E-mail address:PBenharash@mednet.ucla.edu (P. Benharash).

Conceptualization

Methodology

Supervision

Reviewing

Editing

Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

http://orcid.org/0000-0002-4705-0262

* Corresponding author. E-mail address:PBenharash@mednet.ucla.edu (P. Benharash).

1
The authors contributed equally to the work presented in the manuscript

Conflicts of interest

The authors declare no conflicts of interest.

	Non-OUD (n= 3,282,200)	OUD (n=36,057)	p-value
Age (years [IQR])	69 [59‒79]	59 [50‒67]	<0.001
Female (%)	39.9	41.9	<0.001
Type of MI (%)			<0.001
STEMI	24.2	17.2
NSTEMI	75.8	82.8
Income quartile (percentile, %)			<0.001
76‒100^th	16.7	12.5
51‒75^th	23.8	22.0
26‒50^th	28.6	28.3
0‒25^th	30.9	37.3
Insurance Status (%)			<0.001
Private	21.8	14.3
Medicare	62.7	48.9
Medicaid	8.4	27.3
Other Payer	7.1	9.5
Hospital teaching status (%)			<0.001
Non-Metropolitan	7.7	5.3
Metropolitan non-teaching	22.6	22.6
Metropolitan teaching	69.7	72.1
Hospital bed size (%)			0.410
Small	14.8	14.3
Medium	28.1	29.0
Large	57.0	56.7
Comorbidities (%)
Congestive heart failure	29.9	29.0	0.016
Valve disease	15.4	10.9	<0.001
Coagulopathy	8.4	11.3	<0.001
Chronic lung disease	23.9	37.2	<0.001
Pulmonary hypertension	6.7	6.9	0.29
Peripheral vascular disease	12.8	10.7	<0.001
Hypertension	79.7	69.0	<0.001
Diabetes	39.8	30.6	<0.001
Hypothyroidism	12.7	9.7	<0.001
Anemia	4.4	5.2	<0.001
Electrolyte abnormality	33.8	48.9	<0.001
End-stage renal disease	5.9	4.8	<0.001
Liver disease	5.1	15.1	<0.001
Weight loss	6.0	10.2	<0.001
Neurological disorders	12.5	23.0	<0.001
Psychiatric disorder, excluding SUD	10.5	24.2	<0.001
Comorbid Substance Use Disorder (%)
Alcohol Use Disorder	3.8	12.4	<0.001
Non-opioid drug use disorder	3.2	28.1	<0.001
Tobacco use disorder	46.4	62.2	<0.001

	Non-OUD (n=3,282,200)	OUD (n=36,057)	p-value
Mortality (%)	8.6	8.6	0.79
Major Complications (%)
Cardiogenic shock	6.4	6.0	0.030
Ventricular Tachycardia/Fibrillation	9.2	8.6	0.017
Cardiac Arrest	4.1	5.9	<0.001
Acute Heart Failure	24.8	23.8	0.008
Other Cardiac Complications	2.1	2.0	0.21
Infectious	10.9	19.3	<0.001
Respiratory	15.0	21.7	<0.001
Thromboembolic	1.4	2.0	<0.001
Acute kidney injury	25.8	35.1	<0.001
Stroke	0.8	0.9	0.14
Non-elective 30-day readmission (%)	11.3	16.1	<0.001
Discharge disposition (%)			<0.001
Home	57.5	53.1
Short-term facility	2.8	2.6
Long-term facility	15.5	15.8
Home healthcare	14.5	14.5
Against medical advice	1.1	5.4
Other^a a Comprises in-hospital mortality, transfer to law enforcement, and discharge to an unknown destination.	8.6	8.6
Resource Utilization
Length of stay (days) [IQR]	3 [2‒7]	5 [3‒9]	<0.001
Cost (USD $1,000) [IQR]	18.1 [10.7‒30.6]	18.6 [11.0‒33.1]	<0.001
Revascularization Procedures (%)
Percutaneous Coronary Intervention	29.7	17.8	<0.001
CABG	7.7	5.5	<0.001

	OUD	95% CI	p-value
Clinical outcomes (AOR)
In-hospital mortality, index hospitalization	1.06	0.99 - 1.13	0.06
Cardiogenic shock	1.05	0.98 - 1.13	0.16
Ventricular Tachycardia/Fibrillation	0.98	0.93 - 1.04	0.57
Cardiac Arrest	1.21	1.13 - 1.29	<0.001
Acute Heart Failure	0.99	0.95 - 1.04	0.70
Other Cardiac Complications	0.88	0.79 - 0.98	0.020
Stroke	1.12	0.96 - 1.30	0.16
Thromboembolic Complications	1.13	1.01 - 1.27	0.033
Infectious Complications	1.70	1.63 - 1.77	<0.001
Respiratory Complications	1.42	1.37 - 1.48	<0.001
Acute Kidney Injury	1.50	1.44 - 1.55	<0.001
Resource Utilization (β)
Length of stay (days)	+1.41	1.25 - 1.56	<0.001
Cost (USD $1,000)	+2.83	2.26 - 3.40	<0.001
Non-Home discharge (AOR)	1.38	1.33 - 1.43	<0.001
Non-elective 30-day readmission (AOR)	1.34	1.28 - 1.40	<0.001

	Non-OUD	OUD	p-value
	(n=3,282,200)	(n=36,057)	p-value
In-hospital mortality (%)	6.4	3.6	<0.001
Reason for readmission (%)
Cardiovascular	40.4	32.1	<0.001
CABG	1.1	0.8	0.14
Stent Placement	7.0	5.0	<0.001
Valve repair/replacement	0.4	0.5	0.58
Acute kidney injury	3.3	3.6	0.27
Respiratory	9.5	12.2	<0.001
Endocrine	2.8	3.4	0.07
Gastrointestinal	7.8	6.3	0.003
Infection	11.5	12.4	0.14
Hematological	1.4	1.1	0.18
Skin/soft tissue	1.4	5.0	<0.001
Neurological	3.3	2.9	0.26
Psychiatric disorder	0.7	2.5	<0.001
Length of stay (days) [IQR]	4 [2‒7]	4 [2‒7]	0.31
Cost (USD $1,000) [IQR]	9.5 [5.4‒18.5]	9.5 [5.5‒17.7]	0.93

[1] * Corresponding author. E-mail address:PBenharash@mednet.ucla.edu (P. Benharash).

Brasil

Brasil

Association of opioid use disorder with outcomes of hospitalizations for acute myocardial infarction in the United States

Highlights

Abstract

Objective

Methods

Results

Conclusions