Unplanned care less of an issue, but cardiac rehab and outpatient follow-up does suffer
Patients prescribed opioids at hospital discharge after a heart attack or acute heart failure were not more likely to subsequently show up to the hospital again unplanned, but in fact tended to not complete their cardiac rehabilitation and outpatient follow-up, a study found.
Unplanned healthcare utilization comprising emergency department presentation or readmission within 90 days of discharge was about as common between those who did and didn't get opioids (adjusted HR 1.06, 95% CI 0.87-1.28), no matter the opioid dose, according to Justin Liberman, MD, MPH, of The Vanderbilt Clinic in Nashville, and colleagues, who had hypothesized that opioid use would actually be associated with more of these visits.
Moreover, among those alive 30 days after discharge, 60.1% and 55.0% of the opioid and no-opioid groups admitted that they had failed to complete their planned cardiac rehabilitation and outpatient provider follow-up, with a significant difference between groups (adjusted OR 0.69, 95% CI 0.52-0.91), they wrote in Journal of the American Heart Association.
"Both planned healthcare utilization outcomes are evidenced-based recommendations that reduce the risk of readmission and mortality after an acute cardiac event," Liberman and colleagues noted, adding that the drop in their utilization may partly be explained by induced lethargy, physical instability, medication non-adherence, or even depression in opiate use.
"In addition to the national focus on opioid-related overdose and mortality, it is imperative to understand how opioid use can affect a patient's relationship with the healthcare system ... Our study supports reductions in opioid prescriptions to improve planned healthcare utilization behaviors," the authors said.
Forming the basis of the study were some 2,500 patients admitted for an acute coronary syndrome and/or acute decompensated heart failure at Nashville's Vanderbilt University Medical Center from 2011 to 2015. This group was predominantly white and male and had a median age of 59.
One in five had been discharged with an opioid prescription. These patients shared similar 90-day mortality rates with peers not getting opioids (26.1% vs 21.7%; adjusted HR 1.08, 95% CI 0.84-1.39).
However, it was unclear if patients actually took the opioids prescribed or if they might have already had opioids at home, Liberman's group acknowledged. Other study limitations included its reliance on patient-reported outcomes and its limited generalizability to other healthcare systems.
The study was supported by the National Heart, Lung, and Blood Institute, the National Center for Advancing Translational Sciences, and the Veterans Affairs Office of Academic Affiliations.
Liberman disclosed no relevant relationships with industry.
Journal of the American Heart Association
Source Reference: Liberman JS, et al "Opioid prescriptions at hospital discharge are associated with more postdischarge healthcare utilization" J Am Heart Assoc 2019; DOI:10.1161/JAHA.118.010664.
Read the original article on Medpage Today: How Do Opioids Affect Patients With Cardiac Disease?