• J. Heart Lung Transplant. · Oct 2014

    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, and Peter Eckman.
    • Division of Cardiology, University of Minnesota, Minneapolis, Minnesota. Electronic address: cogsw014@umn.edu.
    • J. Heart Lung Transplant. 2014 Oct 1;33(10):1048-55.

    BackgroundAdvanced 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.MethodsBaseline predictors and outcomes were collected and analyzed from patients with active substance abuse and a 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.ResultsThe 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 (IQR 1.4 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% CI 1.2 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.ConclusionsActive 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.Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

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