The United States is in the kernel of cataclysmic opioid misuse epidemic with over
33,000 deaths per year from both prescription and illegal opioids use. One of the
most common pernicious effects of opioids is on the cardiovascular system. The purpose
of this analysis was to determine the incidence of opioid overdose associated cardiovascular
events and its impact on short-term outcomes. This was a retrospective, observational
study which utilized data from the National Inpatient Sample from January 2005 to
September 2015 using International Classifications of Disease, Ninth Revision, Clinical Modification diagnosis codes to identify patients with opioid overdose and associated cardiovascular
outcomes. Cardiovascular events were mainly divided into the following 3 parts: Ischemic
Events (ischemic stroke and myocardial infarction), acute heart failure, and arrhythmias.
The primary outcome of this study was incidence of any cardiovascular event. This
study analyzed a total of 430,459 patients hospitalized with opioid overdose, out
of which 36,837 (8.6%) had at least 1 cardiovascular event. In all the opioid overdose
hospitalizations, 13,979 (3.2%) developed ischemic events, 3,074 (0.7%) developed
acute heart failure, and 22,444 (5.2%) developed arrhythmia. Opioid overdose patients
with new-onset cardiovascular events had higher odds for in-hospital mortality (odds
ratio 4.55; 95% confidence interval 4.11 to 5.04, p <0.001) as compared to patients
without cardiovascular events in the multivariable-adjusted model. This study group
also demonstrated longer length of stay and higher cost of hospitalization associated
with opioid overdose and associated cardiovascular outcome. In conclusion, opioid
overdose is associated with higher rates of cardiovascular events, particularly ischemic
events and cardiac arrhythmias. These adverse events eventually lead to higher mortality
rates and more resource utilization.
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References
Hedegaard H, Miniño AM, Warner M. Drug Overdose Deaths in the United States, 1999-2017. NCHS Data Brief, no 329. Hyattsville, MD: National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db329.htm. Accessed on January 1, 2019.
Department of Justice Drug Enforcement Administration. Automation of reports and consolidated orders system (ARCOS) (http://www.deadiversion.usdoj.gov/arcos/index.html). Accessed on January 1, 2019.
Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths - United States, 2013-2017. Morb Mortal Wkly Rep. https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm. Accessed on January 1, 2019.
- The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013.Med Care. 2016; 54: 901-906
- Cardiac effects of opioid therapy.Pain Med. 2015; 16: S27-S31
- Association between opioid use and atrial fibrillation: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.JAMA Intern Med. 2015; 175: 1058-1060
- Corrected QT interval prolongation during anesthetic induction for laryngeal mask airway insertion with or without cisatracurium.J Int Med Res. 2018; 46: 1990-2000
- ECG abnormalities in co-proxamol (paracetamol/dextropropoxyphene) poisoning.Clin Toxicol (Phila). 2005; 43: 255-259
- Opioid use for noncancer pain and risk of myocardial infarction amongst adults.J Intern Med. 2013; 273: 511-526
- Coronary artery disease and opioid use.Am J Cardiol. 2004; 93: 1295-1297
- The economic burden of abuse of prescription opioids: a systematic literature review from 2012 to 2017.Appl Health Econ Health Policy. 2018; 16: 609-632
- Burden of arrhythmia in hospitalizations with opioid overdose.Int J Cardiol. 2019; 286: 73-75
- Trends and cost of heart transplantation and left ventricular assist devices: impact of proposed federal cuts.JACC Heart Fail. 2018; 6: 424-432
- Trends in the use of percutaneous ventricular assist devices: analysis of national inpatient sample data, 2007 through 2012.JAMA Intern Med. 2015; 175: 941-950
- National trends in hospitalizations for opioid poisonings among children and adolescents, 1997 to 2012.JAMA Pediatr. 2016; 170: 1195-1201
- Perioperative major adverse cardiovascular and cerebrovascular events associated with noncardiac surgery.JAMA Cardiol. 2017; 2: 181-187
- Characteristics of hospitalizations for heart failure with preserved ejection fraction.Am J Med. 2016; 129 (e615-626)635
- Incidence of arrhythmias and impact of permanent pacemaker implantation in hospitalizations with transcatheter aortic valve replacement.Clin Cardiol. 2018; 41: 640-645
- Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis.JAMA. 2011; 306: 2248-2254
- Evaluation of the incidence of new-onset atrial fibrillation after aortic valve replacement.JAMA Intern Med. 2019; 8: 1122-1130
- Adherence to methodological standards in research using the National Inpatient Sample.JAMA. 2017; 318: 2011-2018
- With great power comes great responsibility: big data research from the National Inpatient Sample.Circ Cardiovasc Qual Outcomes. 2017; 10
- Opioids and cardiac arrhythmia: a literature review.Med Princ Pract. 2018; 27: 401-414
- Atrial fibrillation is associated with morphine treatment in female breast cancer patients: a retrospective population-based time-dependent cohort study.Medicine (Baltimore). 2016; 95: e3102
- Risk factors for serious prescription opioid-related toxicity or overdose among Veterans Health Administration patients.Pain Med. 2014; 15: 1911-1929
- Coronary heart disease outcomes among chronic opioid and cyclooxygenase-2 users compared with a general population cohort.Pharmacoepidemiol Drug Saf. 2011; 20: 754-762
- Heroin abuse and myocardial infarction.Int J Cardiol. 1994; 47: 180-182
- Accuracy of ICD-9-CM codes for identifying cardiovascular and stroke risk factors.Med Care. 2005; 43: 480-485
- Exposure-response association between concurrent opioid and benzodiazepine use and risk of opioid-related overdose in medicare part d beneficiaries.JAMA Network Open. 2018; 1e180919
- Association of chronic kidney disease with in-hospital outcomes of transcatheter aortic valve replacement.JACC Cardiovasc Interv. 2017; 10: 2050-2060
Article info
Publication history
Published online: August 23, 2019
Received in revised form:
July 26,
2019
Received:
June 20,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
