Lead investigator Sunil Sharma, MD, the director of the West Virginia University Medical ICU in Morgantown, and colleagues explored both the impact and prevalence of opiate use in adults hospitalized for acute heart-failure (HF) exacerbation. In an article published in September 2019 in The Annals of the American Thoracic Society, the authors reported that subjects “were considered exposed to opioids if they received at least one dose during their stay in the hospital.” The team selected a group of adult subjects who were admitted to the hospital for acute HF, and after screening for SDB using the STOP-BANG questionnaire, the patients received a portable sleep study (PSS). In order to evaluate the patients’ opiate use, the team conducted a retrospective chart review. A subsequent report of transfer to the intensive care unit or 30-day readmission were recorded as an associated “escalation of care.”
The researchers highlighted their findings from the study, which included 301 adult patients admitted with acute HF between November 2016 and October 2017 and who received SDB screening and subsequent PSS. There were 149 (49.5%) individuals who were considered at high risk of SDB, with a apnea–hypopnea index (AHI) score greater than or equal to 10/h by PSS. In this high-risk group, 47 of 149 (32%) were prescribed and administered opiate medication, and of this group, escalation of care occurred in 12 of 47 (26%) versus 4 of 102 (4%) individuals who did not (P <.001). Furthermore, hospital readmission in under 30 days occurred in 7 of 47 (15%) of those who were prescribed opiates versus 9 of 102 (9%) who were not (P = .14).
According to Dr. Sharma in a recent interview, the opiate regimens administered to these high-risk patients were to “manage back pain, arthritis and gout, or as part of their home medication regimen.” He added, “This is the first study, to our knowledge, to assess the impact of opioid administration on escalation of care in patients with undiagnosed SDB admitted for acute [HF].” The incidence of opioid use in these high-risk hospitalized patients “was quite high,” Dr. Sharma said, at nearly 42%, which highlights how difficult it remains to reduce inappropriate opioid use.
Commenting further, Dr. Sharma acknowledged some of the study limitations, adding, “It is possible that these findings are unique to the underserved population at our medical center, due to poor socioeconomic status and the increased probability of chronic therapeutic opioid use and abuse. Thus, replicating these findings at a dissimilar institution is warranted.”
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