Discharge Opioid Rx for Heart Dz Patients May Impact Follow-Up
Findings seen in patients with admitting diagnosis of acute coronary syndrome, decompensated heart failure
FRIDAY, Feb. 15, 2019 (Pharmacist's Briefing) -- For patients with an admitting diagnosis of acute coronary syndrome and/or acute decompensated heart failure, opioid prescription at discharge is not significantly associated with unplanned health care utilization or mortality but is associated with reduced odds of completed planned health care utilization, according to a study published in the Feb. 5 issue of the Journal of the American Heart Association.
Justin S. Liberman, M.D., M.P.H., from the Veterans Health Administration Valley VA Health Care System Geriatric Research Education Clinical Center in Nashville, Tennessee, and colleagues performed a nested evaluation involving 3,000 patients from the Vanderbilt Inpatient Cohort Study with an admitting diagnosis of acute coronary syndrome and/or acute decompensated heart failure. Twenty percent of the 2,495 eligible patients were discharged with an opioid prescription.
The researchers found no significant association between discharge with an opioid prescription and increased unplanned health care utilization (adjusted hazard ratio, 1.06; 95 percent confidence interval, 0.87 to 1.28) or mortality (adjusted hazard ratio, 1.08; 95 percent confidence interval, 0.84 to 1.39) compared with those not prescribed opioids at discharge. The likelihood of completing planned health care utilization was reduced for patients discharged with opioids (adjusted odds ratio, 0.69; 95 percent confidence interval, 0.52 to 0.91).
"Our study supports reductions in opioid prescriptions to improve planned health care utilization behaviors," the authors write. "Further research is necessary to understand opioid use and its association with patient self-care to improve clinical outcomes."