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Frequency of Cardiovascular Events and In-hospital Mortality With Opioid Overdose Hospitalizations

      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

      1. 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.

      2. 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.

      3. 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.

        • Florence CS
        • Zhou C
        • Luo F
        • Xu L
        The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013.
        Med Care. 2016; 54: 901-906
        • Chen A
        • Ashburn MA
        Cardiac effects of opioid therapy.
        Pain Med. 2015; 16: S27-S31
        • Qureshi WT
        • O'Neal WT
        • Khodneva Y
        • Judd S
        • Safford MM
        • Muntner P
        • Soliman EZ
        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
        • Xuan C
        • Wu N
        • Li Y
        • Sun X
        • Zhang Q
        • Ma H
        Corrected QT interval prolongation during anesthetic induction for laryngeal mask airway insertion with or without cisatracurium.
        J Int Med Res. 2018; 46: 1990-2000
        • Afshari R
        • Maxwell S
        • Dawson A
        • Bateman DN
        ECG abnormalities in co-proxamol (paracetamol/dextropropoxyphene) poisoning.
        Clin Toxicol (Phila). 2005; 43: 255-259
        • Li L
        • Setoguchi S
        • Cabral H
        • Jick S
        Opioid use for noncancer pain and risk of myocardial infarction amongst adults.
        J Intern Med. 2013; 273: 511-526
        • Marmor M
        • Penn A
        • Widmer K
        • Levin RI
        • Maslansky R
        Coronary artery disease and opioid use.
        Am J Cardiol. 2004; 93: 1295-1297
        • Reinhart M
        • Scarpati LM
        • Kirson NY
        • Patton C
        • Shak N
        • Erensen JG
        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
        • Doshi R
        • Shah J
        • Desai R
        • Gullapalli N
        Burden of arrhythmia in hospitalizations with opioid overdose.
        Int J Cardiol. 2019; 286: 73-75
        • Patel N
        • Kalra R
        • Doshi R
        • Bajaj NS
        • Arora G
        • Arora P
        Trends and cost of heart transplantation and left ventricular assist devices: impact of proposed federal cuts.
        JACC Heart Fail. 2018; 6: 424-432
        • Khera R
        • Cram P
        • Lu X
        • Vyas A
        • Gerke A
        • Rosenthal GE
        • Horwitz PA
        • Girotra S
        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
        • Gaither JR
        • Leventhal JM
        • Ryan SA
        • Camenga DR
        National trends in hospitalizations for opioid poisonings among children and adolescents, 1997 to 2012.
        JAMA Pediatr. 2016; 170: 1195-1201
        • Smilowitz NR
        • Gupta N
        • Ramakrishna H
        • Guo Y
        • Berger JS
        • Bangalore S
        Perioperative major adverse cardiovascular and cerebrovascular events associated with noncardiac surgery.
        JAMA Cardiol. 2017; 2: 181-187
        • Goyal P
        • Almarzooq ZI
        • Horn EM
        • Karas MG
        • Sobol I
        • Swaminathan RV
        • Feldman DN
        • Minutello RM
        • Singh HS
        • Bergman GW
        • Wong SC
        • Kim LK
        Characteristics of hospitalizations for heart failure with preserved ejection fraction.
        Am J Med. 2016; 129 (e615-626)635
        • Doshi R
        • Decter DH
        • Meraj P
        Incidence of arrhythmias and impact of permanent pacemaker implantation in hospitalizations with transcatheter aortic valve replacement.
        Clin Cardiol. 2018; 41: 640-645
        • Walkey AJ
        • Wiener RS
        • Ghobrial JM
        • Curtis LH
        • Benjamin EJ
        Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis.
        JAMA. 2011; 306: 2248-2254
        • Kalra R
        • Patel N
        • Doshi R
        • Arora G
        • Arora P
        Evaluation of the incidence of new-onset atrial fibrillation after aortic valve replacement.
        JAMA Intern Med. 2019; 8: 1122-1130
        • Khera R
        • Angraal S
        • Couch T
        • Welsh JW
        • Nallamothu BK
        • Girotra S
        • Chan PS
        • Krumholz HM
        Adherence to methodological standards in research using the National Inpatient Sample.
        JAMA. 2017; 318: 2011-2018
        • Khera R
        • Krumholz HM
        With great power comes great responsibility: big data research from the National Inpatient Sample.
        Circ Cardiovasc Qual Outcomes. 2017; 10
        • Behzadi M
        • Joukar S
        • Beik A
        Opioids and cardiac arrhythmia: a literature review.
        Med Princ Pract. 2018; 27: 401-414
        • Lee CW
        • Muo CH
        • Liang JA
        • Lin MC
        • Kao CH
        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
        • Zedler B
        • Xie L
        • Wang L
        • Joyce A
        • Vick C
        • Kariburyo F
        • Rajan P
        • Baser O
        • Murrelle L
        Risk factors for serious prescription opioid-related toxicity or overdose among Veterans Health Administration patients.
        Pain Med. 2014; 15: 1911-1929
        • Carman WJ
        • Su S
        • Cook SF
        • Wurzelmann JI
        • McAfee A
        Coronary heart disease outcomes among chronic opioid and cyclooxygenase-2 users compared with a general population cohort.
        Pharmacoepidemiol Drug Saf. 2011; 20: 754-762
        • Sztajzel J
        • Karpuz H
        • Rutishauser W
        Heroin abuse and myocardial infarction.
        Int J Cardiol. 1994; 47: 180-182
        • Birman-Deych E
        • Waterman AD
        • Yan Y
        • Nilasena DS
        • Radford MJ
        • Gage BF
        Accuracy of ICD-9-CM codes for identifying cardiovascular and stroke risk factors.
        Med Care. 2005; 43: 480-485
        • Hernandez I
        • He M
        • Brooks MM
        • Zhang Y
        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
        • Gupta T
        • Goel K
        • Kolte D
        • Khera S
        • Villablanca PA
        • Aronow WS
        • Bortnick AE
        • Slovut DP
        • Taub CC
        • Kizer JR
        • Pyo RT
        • Abbott JD
        • Fonarow GC
        • Rihal CS
        • Garcia MJ
        • Bhatt DL
        Association of chronic kidney disease with in-hospital outcomes of transcatheter aortic valve replacement.
        JACC Cardiovasc Interv. 2017; 10: 2050-2060