Illicit stimulant use in a United States heart failure population presenting to the emergency department (from the Acute Decompensated Heart Failure National Registry Emergency Module).
Level 3 - non-randomized controlled study
Multi-center observational registry cohort study comparing clinical characteristics and outcomes between exposed and unexposed groups.
PubMed 18940295 · doi:10.1016/j.amjcard.2008.06.045
What was done
Investigators analyzed data from 83 U.S. emergency departments in the Acute Decompensated Heart Failure National Registry Emergency Module (ADHERE-EM) from January 2004 to March 2006. They evaluated 11,258 patients presenting with acute decompensated heart failure (ADHF) to determine the prevalence of self-reported current or past illicit stimulant use and compared clinical characteristics, left ventricular ejection fraction, and in-hospital mortality between stimulant users and nonusers.
What was found
Of 11,258 patients with ADHF, 594 (5.3%) self-reported current or past stimulant drug use. Compared with nonusers, stimulant users were younger (median age 49.7 vs 76.1 years), more likely to be African American (odds ratio 11.9, 95% confidence interval 9.8 to 14.4), and more likely to have a left ventricular ejection fraction <40% (odds ratio 3.4, 95% confidence interval 2.8 to 4.2). Among admitted patients, risk-adjusted mortality did not differ significantly between users and nonusers (adjusted odds ratio 0.83, 95% confidence interval 0.25 to 2.72).
Why it matters
This study shows that illicit stimulant use is present in a meaningful subset of emergency department heart failure presentations and characterizes these patients as a distinct, much younger cohort with severe systolic dysfunction, despite showing similar in-hospital mortality to older nonusers.
Limits
Drug use was determined entirely by self-report rather than objective toxicology screening, creating a high likelihood of underreporting and misclassification. The risk-adjusted mortality estimate had wide confidence intervals (0.25 to 2.72), indicating low statistical precision for in-hospital death. Post-discharge outcomes, drug dosage, and specific stimulant types were not reported in the abstract.
Cited by
- supports Stimulant use, particularly cocaine, is associated with a high incidence of heart failure and premature cardiac death.