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

IF 3.7 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

ESC Heart Failure Pub Date : 2025-05-21 DOI:10.1002/ehf2.15118

Charles Fauvel, Jean-Guillaume Dillinger, Thomas Bochaton, Thomas Levasseur, Amine El Ouahidi, Cyril Zakine, Antony El Hadad, Nicolas Mansencal, Nathalie Noirclerc, Marc Goralski, Christophe Thuaire, Nathan Mewton, Guillaume Schurtz, Pascal Lim, Thibaut Pommier, Léo Lemarchand, Quentin Laissac, Nicolas Lamblin, Tanissia Boukertouta, Damien Logeart, Alain Cohen-Solal, Patrick Henry, Théo Pezel, for the ADDICT-ICCU Investigators

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引用次数: 0

Abstract

Aims

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).

Methods

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).

Results

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).

Conclusions

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.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05063097.

Abstract Image

查看原文本刊更多论文

急性心力衰竭患者药物滥用检测的院内及1年增量预后价值。

目的：本研究旨在评估在急性心力衰竭（AHF）住院患者的连续队列中，通过系统尿液筛查检测到的近期药物滥用的住院和1年增量预后价值。方法：这项前瞻性多中心研究（39个法国中心）纳入了所有接受尿液检测药物滥用筛查的AHF患者。结果为：(i)院内主要不良心血管事件（mace），定义为全因死亡、复苏性心脏骤停或心源性休克；（ii） 1年mace定义为心血管死亡或AHF住院。采用c指数、整体χ2和似然比（LR）检验、净重分类改善（NRI）和综合判别改善（IDI）评估增量预后价值。结果：共纳入458例AHF患者（平均年龄68±14岁，67%为男性，79%为新发心力衰竭）。住院和1年mace分别发生65例（14.2%）和129例（28.2%）。药物滥用检测与院内mace独立相关[模型1-已知合并症：优势比(OR) = 4.46, 95%可信区间（CI）（1.88-10.3）， P]结论：药物滥用与院内和1年mace的较高发生率独立相关，且具有递增的预后价值。这些结果提示对这些患者进行系统的非法药物筛选的潜在兴趣。试验注册：ClinicalTrials.gov标识符：NCT05063097。

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来源期刊

ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

7.00

自引率

7.90%

发文量

461

审稿时长

12 weeks

期刊介绍： ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.