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

Rebecca Cogswell, Elisa Smith, Aimee Hamel, Lillian Bauman, Angela Herr, Sue Duval, Ranjit John, Deborah Roman, Sirtaz Adatya, Monica Colvin-Adams, Daniel Garry, Cindy Martin, Emil Missov, Marc Pritzker, Justin Roberts, Peter Eckman

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

BACKGROUND: Advanced heart failure teams are often faced with the decision of whether or not to offer a left ventricular assist device (LVAD) to patients who have end-stage heart failure and recent or ongoing substance abuse. The outcomes of these patients after LVAD implantation are unknown.

METHODS: Baseline predictors and outcomes were collected and analyzed from patients with active substance abuse anda cohort of patients without active substance abuse matched for age, INTERMACS profile and year of implantation. The primary outcome was all-cause mortality. Secondary outcomes included rates of listing for cardiac transplantation, transplantation and chronic drive-line infection.

RESULTS: The cohort consisted of 20 consecutive LVAD recipients with active substance abuse and 40 recipients without active substance abuse. During a median follow-up period of 2.3 years (IQR1.4 to 3.6), the substance abuse group had 3.2 times the rate (hazard) of death compared with a matched cohort (HR 3.2, 95%CI1.2 to 8.0, p < 0.05). Furthermore, the rate of listing for transplant was 69% lower (rate ratio 0.31, p < 0.0005), rate of cardiac transplant was 89% lower (rate ratio 0.11, p < 0.0005), and risk of chronic drive-line infection was 5.4 times higher (rate ratio 5.4, p < 0.0005) in the substance abuse group.

CONCLUSIONS: Active substance abuse in patients who received an LVAD was associated with increased mortality and overall poor outcomes. Larger scale data will be needed to confirm these findings and to inform decision-making in this population.

Original languageEnglish (US)
Pages (from-to)1048-1055
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume33
Issue number10
DOIs
StatePublished - Oct 1 2014

Bibliographical note

Publisher Copyright:
© 2014 International Society for Heart and Lung Transplantation. All rights reserved.

Keywords

  • assist
  • device
  • failure
  • heart
  • left
  • mortality
  • outcomes
  • substance abuse
  • substance dependence
  • ventricular

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