Substance Use Disorder in a National Heart Failure Cohort: Risk for Hospital Readmission and Mortality

Background: Heart failure (HF) and substance use disorder (SUD) are independently associated with morbidity and mortality. How SUD influences HF outcomes has not been described longitudinally in a national cohort. Methods: Retrospective study of adult patients with a primary diagnosis of HF enrolled in the Optum Clinformatics Data Mart (2010-2020), stratified by history of SUD (any time; prior or current use; substance type) compared to no SUD history. Logistic regression analyses were conducted in propensity score 1:1 matched (PSM) cohorts. Outcomes were 30-day, 180-day, and 1-year hospital readmission and mortality. Results: Study included 194,020 patients, 11,611 (6.0%) with documented SUD at any time. Prior to matching, patients with SUD were younger, more often male, and with fewer comorbidities compared to no history of SUD. In the PSM analysis, SUD was associated with greater 30-day [21.1% vs. 15.0%, p < 0.001], 180-day [54.7% vs. 41.9%, p < 0.001], and 1-year [67.9% vs. 55.4%, p < 0.001] hospital readmission. Thirty-day [1.6% vs. 1.0%, p < 0.001], 180-day [5.9% vs. 4.2%, p < 0.001] and 1-year [15.4% vs. 12.5%, p < 0.001] mortality was also higher in patients with SUD. In multivariable analyses, SUD remained independently associated with higher odds of poorer outcomes. Risk was retained when SUD was restricted to use prior to or at time of index hospitalization. Methamphetamine and other stimulant use were associated with an increased risk of hospital readmission across all time points, and an increased risk of mortality at one year. Conclusions: In patients with HF, SUD was independently associated with an increased risk of hospital readmissions and mortality.