In-hospital and 1 year incremental prognostic value of drug abuse detection in acute heart failure

The study aims to assess the in-hospital and 1 year incremental prognostic value of recent drug abuse use, detected by a systematic urinary screening, in a consecutive cohort of patients hospitalized for acute heart failure (AHF).

All patients admitted for AHF with a drug abuse screening using a urinary assay were included in this prospective multicentric study (39 French centres). The outcomes were (i) in-hospital major adverse cardiovascular events (MACEs) defined as all-cause death, resuscitated cardiac arrest or cardiogenic shock; and (ii) 1 year MACEs defined as cardiovascular death or hospitalization for AHF. Incremental prognostic value was assessed using the C-index, the global χ² and likelihood-ratio (LR) test, the net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

In total, 458 patients with AHF were included (mean age 68 ± 14 years, 67% male, 79% of new heart failure onset). In-hospital and 1 year MACEs occurred, respectively, in 65 (14.2%) and 129 (28.2%) patients. Drug abuse detection was independently associated with in-hospital MACEs [model 1-known comorbidities: odds ratio (OR) = 4.46, 95% confidence interval (CI) (1.88-10.3), P < 0.001; model 2-clinical severity: OR = 3.64, 95% CI (1.56-8.26), P = 0.002], even after propensity-matched population analysis [OR = 3.34, 95% CI (1.32-8.70), P = 0.011], with a significant incremental prognostic value over and above traditional risk factors (C-statistic improvement 0.04 with LR test P < 0.001 for both models). Patients with drug abuse detection had worse 1 year survival: HR = 1.82, 95% CI (1.13-2.92), P = 0.012. Drug abuse detection was independently associated with 1 year MACEs after adjustment with traditional prognosticators [OR = 2.54, 95% CI (1.28-4.98), P = 0.008] and propensity-matched population analysis [OR = 2.77, 95% CI (1.98-5.21), P = 0.001], with an incremental prognostic value as well (C-statistic improvement 0.02, LR test P < 0.001, positive NRI and IDI).

Drug abuse use was independently associated with a higher occurrence of both in-hospital and 1 year MACEs with an incremental prognostic value. These results suggest a potential interest of a systematic illicit drug screening in these patients.

ClinicalTrials.gov Identifier: NCT05063097.