Prevalence and impact of recreational drug use in patients with acute cardiovascular events

• Published in: Heart (British Cardiac Society) Vol. 109; no. 21; pp. 1608 - 1616
• Main Authors: Pezel, Théo, Jean-Guillaume Dillinger, Trimaille, Antonin, Delmas, Clément, Piliero, Nicolas, Bouleti, Claire, Pommier, Thibaut, Amine El Ouahidi, Andrieu, Stéphane, Lattuca, Benoit, Vasram, Reza Rossanaly, Fard, Damien, Noirclerc, Nathalie, Bonnet, Guillaume, Goralski, Marc, Meyer Elbaz, Deney, Antoine, Schurtz, Guillaume, Docq, Clemence, Roubille, Francois, Fauvel, Charles, Bochaton, Thomas, Aboyans, Victor, Boccara, Franck, Puymirat, Etienne, Batisse, Anne, Steg, Gabriel, Vicaut, Eric, Henry, Patrick
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.11.2023; BMJ Publishing Group
• Subjects: Acute coronary syndromes; Amphetamines; Cardiology; Cardiology and cardiovascular system; Cocaine; Drug use; Ecstasy; Heart attacks; Hemodynamics; Heroin; Hospitalization; Human health and pathology; Life Sciences; Marijuana; Narcotics; Patients; Recreational drugs; Regression analysis; Santé publique et épidémiologie; Urine; France; outcome assessment; drug interactions; acute coronary syndrome; health care
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2023-322520

ObjectiveWhile recreational drug use is a risk factor for cardiovascular events, its exact prevalence and prognostic impact in patients admitted for these events are not established. We aimed to assess the prevalence of recreational drug use and its association with in-hospital major adverse events (MAEs) in patients admitted to intensive cardiac care units (ICCU).MethodsIn the Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study, systematic screening for recreational drugs was performed by prospective urinary testing all patients admitted to ICCU in 39 French centres from 7 to 22 April 2021. The primary outcome was prevalence of recreational drug detection. In-hospital MAEs were defined by death, resuscitated cardiac arrest, or haemodynamic shock.ResultsOf 1499 consecutive patients (63±15 years, 70% male), 161 (11%) had a positive test for recreational drugs (cannabis 9.1%, opioids 2.1%, cocaine 1.7%, amphetamines 0.7%, 3,4-methylenedioxymethamphetamine (MDMA) 0.6%). Only 57% of these patients declared recreational drug use. Patients who used recreational drugs exhibited a higher MAE rate than others (13% vs 3%, respectively, p<0.001). Recreational drugs were associated with a higher rate of in-hospital MAEs after adjustment for comorbidities (OR 8.84, 95% CI 4.68 to 16.7, p<0.001). After adjustment, cannabis, cocaine, and MDMA, assessed separately, were independently associated with in-hospital MAEs. Multiple drug detection was frequent (28% of positive patients) and associated with an even higher incidence of MAEs (OR 12.7, 95% CI 4.80 to 35.6, p<0.001).ConclusionThe prevalence of recreational drug use in patients hospitalised in ICCU was 11%. Recreational drug detection was independently associated with worse in-hospital outcomes.Clinical trial registrationNCT05063097.