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Substance abuse at the time of left ventricular assist device implantation is associated with increased mortality

Rebecca Cogswell1, Elisa Smith1, Aimee Hamel1

  • 1Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|August 10, 2014
PubMed

Insights

Patients with active substance abuse receiving a left ventricular assist device (LVAD) have significantly higher mortality and worse outcomes. This highlights the need for careful consideration in managing these advanced heart failure patients.

Area of Science:

  • Cardiology
  • Transplantation Surgery
  • Addiction Medicine

Background:

  • Advanced heart failure management decisions often involve left ventricular assist devices (LVADs).
  • Patient selection for LVADs can be complex, particularly in those with active substance abuse.
  • Outcomes for patients with substance abuse undergoing LVAD implantation are not well-established.

Purpose of the Study:

  • To compare outcomes of LVAD recipients with active substance abuse versus those without.
  • To identify predictors of mortality and adverse events in LVAD patients with substance abuse.
  • To inform clinical decision-making regarding LVAD implantation in patients with substance abuse.

Main Methods:

  • A retrospective analysis comparing 20 LVAD recipients with active substance abuse to 40 matched controls without substance abuse.
  • Matching criteria included age, INTERMACS profile, and year of implantation.
  • Primary outcome was all-cause mortality; secondary outcomes included transplant listing, transplantation, and chronic drive-line infections.

Main Results:

  • The substance abuse group exhibited a 3.2-fold increased hazard of death compared to the control group.
  • Rates of transplant listing and cardiac transplantation were significantly lower in the substance abuse group.
  • The risk of chronic drive-line infection was 5.4 times higher in patients with active substance abuse.

Conclusions:

  • Active substance abuse is associated with increased mortality and poorer outcomes in LVAD recipients.
  • These findings suggest caution and further investigation are warranted when considering LVADs for patients with substance abuse.
  • Larger studies are needed to confirm these results and guide clinical practice for this patient population.
Abstract

Keywords:
heart failureleft ventricular assist devicemortalityoutcomessubstance abusesubstance dependence

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