Recreational drugs are detected in more than 1 in 10 heart patients

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Recreational drug use may be a factor in a significant proportion of admissions to cardiac intensive care, as different substances are detected in 1 in 10 patients, suggest results of a French multicentre study published online in the journal Neurosurgery. heart.

Using the drugs was also associated with significantly worse outcomes, with users about 9 times more likely to die or need emergency intervention than other heart patients while in the hospital, and 12 times as likely if they used more than one drug.

The researchers explain that recreational drug use is a known risk factor for cardiovascular events, such as a heart attack or an irregular heartbeat (atrial fibrillation). They added that an estimated 275 million people around the world indulged in this activity in 2022, a 22% increase from the 2010 figure.

But it’s not clear how common recreational drug use is among patients admitted to hospital with heart problems, or how much it affects the potential course of their condition.

To try to find out, the researchers analyzed urine samples of all patients admitted to cardiac intensive care in 39 French hospitals during two weeks in April 2021, with the aim of detecting recreational drug use.

During this period, 1904 patients were admitted, 1499 of whom provided a urine sample – mean age 63, 70% male. Of these, 161 (11%) tested positive for various recreational drugs, but just over half (57%) admitted to using them.

Prevalence was highest among people under 40 years of age, of whom 1 in 3 (33%) tested positive for recreational drugs.

The most frequently detected substances were cannabis (9%), followed by opiates (2%), cocaine (just under 2%), amphetamines (about 1%), and ecstasy (just over 0.5%).

Compared to other non-use heart patients, users were more likely to die or require emergency intervention for events such as cardiac arrest or acute circulatory failure (haemodynamic shock) while in hospital: 3% vs 13% – especially if they had been admitted due to heart failure or a certain type of heart attack (STEMI).

After adjusting for other underlying conditions, such as HIV, diabetes, and high blood pressure, users were about 9 times more likely to die or need emergency treatment.

While cannabis, cocaine, and ecstasy were all independently associated with these incidents, and one drug use was detected in nearly 3 in 4 patients (72%), multiple drug use was detected in more than 1 in 4 (28%) Users: These patients were at higher risk, as they were 12 times more likely to die or need emergency treatment.

This is an observational study, so it cannot be shown that recreational drug use led to admission to cardiac intensive care. The researchers also acknowledge that the study was conducted over only two weeks in April, so the results may not apply to other months of the year or in the long term.

They cautioned, “Although the strong association between recreational drug use and the incidence of[major adverse events]suggests an important prognostic role, the limited number of events requires caution in the clinical interpretation of these findings.”

But they show that recreational drugs can increase blood pressure, heart rate and temperature, and thus the heart’s need for oxygen.

They concluded, “While current guidelines only recommend a permissive survey to investigate recreational drug use, these findings indicate the potential value of urine screening in selected patients with acute cardiovascular events to improve risk stratification in[cardiac intensive care].”

In a linked editorial, doctors from St Bartholomew’s Hospital in London and Queen Mary University of London stressed that the study was not designed to reveal a causal relationship. Larger studies will be needed to try to prove this.

But the study findings raise two obvious questions, they suggest, “(1) should patients admitted to cardiac intensive care units be screened for recreational drug use: and (2) what interventions, if any, could be implemented after the patient’s test result positivity?

They suggest that knowing that a patient has used recreational drugs may shed light on the cause of their condition and explain how to manage it. It may have other benefits as well.

“A positive test result will provide an opportunity to provide counseling about the negative medical, psychological and social effects of drugs, and to implement interventions aimed at stopping drug use,” they wrote.

But aside from cost, screening raises issues of patient confidentiality and differentiability in how targeted screening is applied, they say.

They concluded, “There is a long way to go, however, before screening for recreational drug use can be advised.”

more information:
Prevalence and impact of recreational drug use in patients with acute cardiovascular events, heart (2023). DOI: 10.1136/heartjnl-2023-322520

Journal information:

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