Rates of Opioid-Related Cardiac Arrest Rising in US

Results of a study detailing a rapid increase in rate of opioid-induced cardiac arrests in the US is making waves at the European Society of Cardiology (ESC) Congress 2021.

An analysis of more than 1.4 million cardiac arrest hospitalizations spanning 2012-2018, results suggest a significant rise in opioid-associated cardiac arrest to the point where rates were similar to the number of cardiac arrests occurring for any other reason by the end of the study period.

“The rise in opioid-related cardiac arrests during the study period was significant. By 2018, opioids were related to a similar number of cardiac arrests as all other reasons put together,” said Senada Malik, MPH, BSc, fa medical researcher at the University of New England, in a statement. “This was an observational study so we cannot conclude causality, but the findings do suggest that the opioid epidemic in the US may have contributed to an increasing number of cardiac arrests.”

With an interest in developing a greater understanding of contemporary trends of cardiac arrest among patients with and without a history of opioid abuse, Malik and Wilbert Aronow, MD, of the New York Medical College, designed the current study as an analysis of data from the US Nationwide Readmission Database, which is a database developed for the Healthcare Cost and Utilization Project and collects data related to 18 million discharges per year. Using this database, investigators identified a total of 1,410,475 cardiac arrest hospitalizations occurring from 2012-2018.

For the purpose of analysis, patients were stratified according to whether or not they received a secondary diagnosis of opioid disease during hospitalization. The primary outcome of interest for the study was inpatient mortality. Investigators pointed out they planned to assess rates of opioid-related cardiac arrest according to year of admission, discharge quarter, age, and sex.

Of the 1,410,475 hospitalizations included in the analysis, 3.1% (n=43,090) received a secondary diagnosis of opioid use. Upon analysis, investigators determined the overall rate of in-hospital mortality among those with opioid use was 56.7% compared to 61.2% among those without a diagnosis of opioid use. When comparing characteristics of these cohorts, investigators found those hospitalized for opioid-related cardiac arrest had a higher prevalence of alcohol abuse (16.9% vs 7.1%; P <.05), depression (18.8% vs 9%; P <.05), and prevalence of smoking (37.0% vs 21.8%; P <.05) than their counterparts without a diagnosis of opioid use.

After adjustment for comorbidities, including liver disease, atrial fibrillation, and renal failure, there were no differences in risk of mortality observed among patients with opioid abuse compared to those without (OR, 0.96 [95% CI, 0.92-1.01]; P=.15). An analysis of rates of opioid-related cardiac arrest according to year of admission revealed a significant increasing trend over the course of the 7-year study period (P <.05).

“The rising use of opioids is having a devastating impact on the lives of many Americans. Abuse of these drugs has been linked with poor lifestyle choices including excessive alcohol intake, lack of exercise, insufficient sleep and smoking – which can lead to a downward spiral of poor decision-making,” added Malik.

This study, “Trends and Outcomes in Opioid Related Cardiac Arrest in a Contemporary US Population from 2012-18,” was presented at ESC Congress 2021.