Trends and outcomes of opioid-related cardiac arrest in a contemporary US population

Published:November 16, 2021DOI:https://doi.org/10.1016/j.ejim.2021.11.004

      Abstract

      Background

      Opioid abuse is a worldwide public health issue, and deaths related to opioid abuse are increasing. We aimed to investigate trends, predictors, and outcomes of cardiac arrest in patients with opioid abuse.

      Methods

      All hospitalizations for primary diagnosis of cardiac arrest between 2012 and 2018 identified in the Nationwide Inpatient Sample were categorized into those with or without a secondary diagnosis of opioid overdose. Multivariable logistic regression was used to analyze in-hospital outcomes of opioid-associated cardiac arrest after adjusting for patient and hospital characteristics.

      Results

      Among 1,410,475 hospitalizations with cardiac arrest, opiate abuse as a secondary diagnosis was found in 3.1% (n=43,090) of hospitalizations, with an increasing trend during the study period. Hospitalizations for cardiac arrest with opioid abuse were seen less likely in patients with heart failure (21.2% vs. 40.6%; p<0.05), diabetes mellitus (19.5% vs. 35.4%; p<0.05), hypertension (43.4% vs. 64.9%; p<0.05) and renal failure (14.3% vs. 30.2%; p<0.05) and more frequently in those with history of alcohol abuse (16.9% vs. 7.1%; p<0.05), depression (18.8% vs. 9%; p<0.05), and smoking (37.0% vs. 21.8%; p<0.05) as compared with cardiac arrest without opioid use. In-hospital mortality in cardiac arrest patients with and without opioids was not different after multivariable adjustment (odds ratio OR 0.96, 0.91-1.00; p=0.07). OA-OHCA was associated with significantly higher risks of acute kidney injury, acute respiratory failure, and mechanical ventilation, p<0.05 for all.

      Conclusion

      Opioid abuse remains a significant cause of cardiac arrest. Despite similar in-hospital mortality and lower resource utilization, severe complications are more frequent in opioid abuse related cardiac arrests compared to those without opioid abuse.

      Keywords

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      References

        • Dezfulian C.
        • Orkin A.M.
        • Maron B.A.
        • et al.
        Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and implications for health care and public responses: a scientific statement from the American Heart Association.
        Circulation. 2021; 143https://doi.org/10.1161/cir.0000000000000958
      1. Cdc.gov. 2021. Understanding the Epidemic | CDC's Response to the Opioid Overdose Epidemic | CDC. https://www.cdc.gov/opioids/basics/epidemic.html.

      2. Cdc.gov. 2021. CDC's Response to the Opioid Overdose Epidemic | CDC's Response to the Opioid Overdose Epidemic | CDC. https://www.cdc.gov/opioids/strategy.html.

      3. Hcup-us.ahrq.gov. 2021. National (Nationwide) Inpatient Sample (NIS). https://www.hcup-us.ahrq.gov/news/exhibit_booth/nis_brochure.jsp.

      4. Hcup-us.ahrq.gov. 2021. NRD Overview. https://www.hcup-us.ahrq.gov/nrdoverview.jsp.

        • Quan H.
        • Sundararajan V.
        • Halfon P.
        • Fong A.
        • Burnand B.
        • Luthi J.
        • et al.
        Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.
        Medical Care. 2005; 43: 1130-1139
        • Gupta T.
        • Khera S.
        • Kolte D.
        • Goel K.
        • Kalra A.
        • Villablanca P.A.
        • et al.
        Transcatheter versus surgical aortic valve replacement in patients with prior coronary artery bypass grafting: trends in utilization and propensity-matched analysis of in-hospital outcomes.
        Circulat Cardiovasc Intervent. 2018; 11e006179