Opioid Use Associated with Atrial Fibrillation in Post-9/11 Veteran Population

Jonathan Stock, MD

Although the risk of overdose has dominated the focus of the opioid epidemic, recent studies have also found an association between opioid use and cardiovascular mortality.

In a study presented at the American Heart Association (AHA) Scientific Sessions 2018, held November 10—12, 2018, in Chicago, Illinois, investigators evaluated a large cohort of young Veterans with few baseline comorbidities in order to investigate whether opioid use is independently associated with atrial fibrillation.

“We were inspired to look into a possible association between opioid use and atrial fibrillation by a recent study which was published showing a possible link between opioid use and cardiovascular mortality,” lead investigator Jonathan Stock, MD, said in an interview with MD Magazine^® .

“The ways that opioids might contribute to cardiovascular mortality is unclear, and we were hoping to shed light on it by investigating a possible link with atrial fibrillation," Stock continued. "We used a large cohort of young Veterans because it has been shown that veterans use opioids at higher rates than the general population, which makes this a particularly important issue for our service men and women.”

The investigators analyzed administrative and clinical data that included patient demographics and clinical comorbidities based on ICD-9 codes from a large cohort of post-9/11 Veterans. For the year 2014-2015, data on opioid use by prescription data were also obtained.

To determine the association between opioid use and atrial fibrillation, the investigators conducted a multivariate logistical regression analysis, adjusting for demographic, medical, and mental health covariates. Within the study window, opioid use was further subdivided by the duration of use.

The study sample included 857,283 Veterans, with the mean age of 38 (SD 9.5 years). Of those participants, 12.7% were female, 59% White, 14.1% African American, and 11% Hispanic. Overall, a diagnosis of atrial fibrillation was found in 3033 Veterans in the study cohort (.354%).

A total of 29.2% of Veterans with atrial fibrillation were prescribed opioids, compared with 15.4% of Veterans without atrial fibrillation.

After adjusting for demographic, medical, and mental health covariates, which included those with known associations to atrial fibrillation risk (odds ratio [OR] = 1.34, 95% CI 1.23 - 1.45, P <.001), opioid prescription was independently associated with the likelihood of having atrial fibrillation. Regarding the duration of opioid prescription in the study window and atrial fibrillation prevalence, no significant trend was observed.

“The hallmark of our study was that opioid use was found to be independently associated with the likelihood of a diagnosis of atrial fibrillation in this cohort of young Veterans.” Stock said. “Much [of the] attention [from the opioid epidemic] focuses on opioid abuse and overdoses, but it is important to also consider the harm that opioid use alone could be causing in order to make us, as physicians, think twice before prescribing these medications that have done so much harm to our communities. We [also saw] that atrial fibrillation was more common in men than women, but that is well known from other studies.”

From their results, the study authors concluded that the independent association of opioid use to diagnosed atrial fibrillation was demonstrated by the analysis and nationwide data. The cohort was also noted for relatively young age for observed atrial fibrillation prevalence.

With the contribution of atrial fibrillation to incident cardiovascular events found in the study, the authors noted that the study’s findings demonstrate 1 pathway by which opioid use may contribute to cardiovascular health.

Looking forward, Stock said, “It would be interesting to explore if there is a relationship between opioid use and other cardiovascular conditions beyond atrial fibrillation. The mechanism through which opioid use may lead to atrial fibrillation is also unclear.”