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Differences in the Clinical Outcome of Ischemic and Nonischemic Cardiomyopathy in Heart Failure With Concomitant

John Gharbin1, Adwoa Winful2, Mubariz Ahmed Hassan1

  • 1Department of Medicine, Howard University Hospital, Washington DC, USA.

Current Problems in Cardiology
|January 23, 2023
PubMed

Insights

Patients with heart failure and opioid use disorder have higher mortality with nonischemic cardiomyopathy. This study found a 36% increased risk of in-hospital death for nonischemic cardiomyopathy patients compared to ischemic cardiomyopathy patients.

Area of Science:

  • Cardiology
  • Public Health
  • Substance Use Disorders

Background:

  • Heart Failure (HF) and Opioid Use Disorder (OUD) pose significant challenges to patients and the US healthcare system.
  • The intersection of OUD and cardiovascular diseases, particularly HF, is a growing area of concern amid the opioid epidemic.
  • Limited research exists on the differential outcomes of ischemic cardiomyopathy (ICM) versus nonischemic cardiomyopathy (NICM) in HF patients with OUD.

Purpose of the Study:

  • To investigate the differential in-hospital mortality and cardiogenic shock incidence between ICM and NICM in patients with HF and OUD.
  • To compare patient demographics, comorbidities, and risk factors between ICM and NICM groups within the HF with OUD population.
  • To provide insights into the specific risks associated with different types of cardiomyopathy in the context of OUD.

Main Methods:

  • Retrospective, observational cohort study utilizing the National Inpatient Sample (NIS) database from 2018-2020.
  • Inclusion criteria: patients aged 18+ with diagnoses of HF and concomitant OUD, categorized into ICM and NICM.
  • Primary outcome: all-cause in-hospital mortality. Secondary outcome: incidence of cardiogenic shock. Statistical analyses controlled for covariates and confounders.

Main Results:

  • The study identified 99,810 hospitalizations meeting inclusion criteria, with ICM accounting for 27%.
  • Patients with ICM were older and had higher rates of cardiovascular risk factors and comorbidities compared to NICM.
  • After adjusting for confounders, NICM was associated with a 36% increased odds of all-cause in-hospital mortality (aOR=1.36; P=0.02) compared to ICM. No significant difference in cardiogenic shock incidence was observed.

Conclusions:

  • In patients with HF and OUD, nonischemic cardiomyopathy is associated with significantly higher in-hospital mortality compared to ischemic cardiomyopathy, despite younger age and fewer comorbidities.
  • The findings underscore the importance of considering cardiomyopathy type when managing HF patients with OUD.
  • Further prospective research is warranted to explore these disparities and inform clinical management strategies.

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