The impact of substance abuse, including alcohol abuse or illicit drug use, on outcomes
after left ventricular assist device (LVAD) implantation, has not been fully elucidated.
Accordingly, to test the hypothesis that such a history would be associated with worse
outcomes, we analyzed the Interagency Registry for Mechanically Assisted Circulatory
Support registry. All patients from the Interagency Registry for Mechanically Assisted
Circulatory Support registry who received a continuous-flow LVAD from June 2006 to
December 2017 were included. The median follow-up duration was 12.9 months (interquartile
range, 5.3 to 17.5). The final study group consisted of 15,069 patients, of which
1,184 (7.9%) had a history of alcohol abuse and 1,139 (7.6%) had a history of illicit
drug use. The overall mortality rates in the alcohol, illicit drug, and control groups
were 25%, 21%, and 29%, respectively. Cox regression analysis showed that having a
history of alcohol abuse (hazard ratio, 0.97, 95% confidence interval, 0.84 to 1.13,
p = 0.72) or illicit drug use (hazard ratio, 1.02, 95% confidence interval, 0.86 to
1.21, p = 0.81) was not significantly associated with increased risk of all-cause
mortality when compared with general LVAD population. On the contrary, after adjusting
for other covariates, a history of alcohol abuse or illicit drug use was significantly
associated with increased device malfunction/pump thrombosis, device-related infection,
or all-cause hospitalization (all p <0.05). Furthermore, After LVAD implantation,
these patients had a lower quality of life assessed by the Kansas City Cardiomyopathy
Questionnaire compared with those who did not. In conclusion, our findings suggest
that patients with a history of alcohol abuse or illicit drug use are at risk for
adverse device-related events with a lower quality of life after continuous-flow LVAD
implantation compared with the general LVAD population.
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Article Info
Publication History
Published online: June 10, 2022
Received in revised form:
April 12,
2022
Received:
January 17,
2022
Footnotes
Source of Funding or Grants: None to Declare
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
