In‐hospital and 1 year incremental prognostic value of drug abuse detection in acute heart failure
Abstract Aims The study aims to assess the in‐hospital and 1 year incremental prognostic value of recent drug abuse use, detected by a systematic urinary screening, in a consecutive cohort of patients hospitalized for acute heart failure (AHF). Methods All patients admitted for AHF with a drug abuse...
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| Language: | English |
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Wiley
2025-08-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.15118 |
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| author | Charles Fauvel Jean‐Guillaume Dillinger Thomas Bochaton Thomas Levasseur Amine El Ouahidi Cyril Zakine Antony El Hadad Nicolas Mansencal Nathalie Noirclerc Marc Goralski Christophe Thuaire Nathan Mewton Guillaume Schurtz Pascal Lim Thibaut Pommier Léo Lemarchand Quentin Laissac Nicolas Lamblin Tanissia Boukertouta Damien Logeart Alain Cohen‐Solal Patrick Henry Théo Pezel for the ADDICT‐ICCU Investigators |
| author_facet | Charles Fauvel Jean‐Guillaume Dillinger Thomas Bochaton Thomas Levasseur Amine El Ouahidi Cyril Zakine Antony El Hadad Nicolas Mansencal Nathalie Noirclerc Marc Goralski Christophe Thuaire Nathan Mewton Guillaume Schurtz Pascal Lim Thibaut Pommier Léo Lemarchand Quentin Laissac Nicolas Lamblin Tanissia Boukertouta Damien Logeart Alain Cohen‐Solal Patrick Henry Théo Pezel for the ADDICT‐ICCU Investigators |
| author_sort | Charles Fauvel |
| collection | DOAJ |
| description | Abstract Aims The study aims to assess the in‐hospital and 1 year incremental prognostic value of recent drug abuse use, detected by a systematic urinary screening, in a consecutive cohort of patients hospitalized for acute heart failure (AHF). Methods All patients admitted for AHF with a drug abuse screening using a urinary assay were included in this prospective multicentric study (39 French centres). The outcomes were (i) in‐hospital major adverse cardiovascular events (MACEs) defined as all‐cause death, resuscitated cardiac arrest or cardiogenic shock; and (ii) 1 year MACEs defined as cardiovascular death or hospitalization for AHF. Incremental prognostic value was assessed using the C‐index, the global χ2 and likelihood‐ratio (LR) test, the net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results In total, 458 patients with AHF were included (mean age 68 ± 14 years, 67% male, 79% of new heart failure onset). In‐hospital and 1 year MACEs occurred, respectively, in 65 (14.2%) and 129 (28.2%) patients. Drug abuse detection was independently associated with in‐hospital MACEs [model 1—known comorbidities: odds ratio (OR) = 4.46, 95% confidence interval (CI) (1.88–10.3), P < 0.001; model 2—clinical severity: OR = 3.64, 95% CI (1.56–8.26), P = 0.002], even after propensity‐matched population analysis [OR = 3.34, 95% CI (1.32–8.70), P = 0.011], with a significant incremental prognostic value over and above traditional risk factors (C‐statistic improvement 0.04 with LR test P < 0.001 for both models). Patients with drug abuse detection had worse 1 year survival: HR = 1.82, 95% CI (1.13–2.92), P = 0.012. Drug abuse detection was independently associated with 1 year MACEs after adjustment with traditional prognosticators [OR = 2.54, 95% CI (1.28–4.98), P = 0.008] and propensity‐matched population analysis [OR = 2.77, 95% CI (1.98–5.21), P = 0.001], with an incremental prognostic value as well (C‐statistic improvement 0.02, LR test P < 0.001, positive NRI and IDI). Conclusions Drug abuse use was independently associated with a higher occurrence of both in‐hospital and 1 year MACEs with an incremental prognostic value. These results suggest a potential interest of a systematic illicit drug screening in these patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05063097. |
| format | Article |
| id | doaj-art-7a9932c28e92499698b10bb0ecfec88a |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-7a9932c28e92499698b10bb0ecfec88a2025-08-20T03:51:44ZengWileyESC Heart Failure2055-58222025-08-011242736274810.1002/ehf2.15118In‐hospital and 1 year incremental prognostic value of drug abuse detection in acute heart failureCharles Fauvel0Jean‐Guillaume Dillinger1Thomas Bochaton2Thomas Levasseur3Amine El Ouahidi4Cyril Zakine5Antony El Hadad6Nicolas Mansencal7Nathalie Noirclerc8Marc Goralski9Christophe Thuaire10Nathan Mewton11Guillaume Schurtz12Pascal Lim13Thibaut Pommier14Léo Lemarchand15Quentin Laissac16Nicolas Lamblin17Tanissia Boukertouta18Damien Logeart19Alain Cohen‐Solal20Patrick Henry21Théo Pezel22for the ADDICT‐ICCU InvestigatorsDepartment of Cardiology Normandie Univ, UNIROUEN, U1096, CHU Rouen Rouen FranceDepartment of Cardiology, Hôpital Lariboisière, Assistance Publique‐Hôpitaux de Paris Université Paris Cité Paris FranceIntensive Cardiological Care Division Louis Pradel Hospital, Hospices Civils de Lyon Lyon FranceService de Cardiologie centre hospitalier de Fréjus/Saint‐Raphaël Fréjus FranceDepartment of Cardiology University Hospital of Brest Brest FranceNCT+ Saint Cyr Sur Loire FranceService de Cardiologie Hôpital MONTFERMEIL Paris FranceService de Cardiologie Boulogne Billancourt, Hôpital Ambroise Pare, University Hospital Center, AP‐HP Paris FranceService de Cardiologie Centre Hospitalier Annecy Genevois Épagny Metz‐Tessy FranceService de Cardiologie Centre Hospitalier d'Orleans Orléans FranceService de Cardiologie Centre Hospitalier de Chartres Le Coudray FranceIntensive Cardiological Care Division Louis Pradel Hospital, Hospices Civils de Lyon Lyon FranceDepartment of Cardiology University Hospital of Lille Lille FranceIntensive Cardiac Care Unit University Hospital Henri Mondor Créteil Paris FranceDepartment of Cardiology University Hospital Dijon FranceCHU Rennes Service de Cardiologie et Maladies Vasculaires Rennes FranceDepartment of Cardiology Normandie Univ, UNIROUEN, U1096, CHU Rouen Rouen FranceDepartment of Cardiology University Hospital of Lille Lille FranceDepartment of Cardiology Hôpital Avicenne, Assistance Publique‐Hôpitaux de Paris Paris FranceDepartment of Cardiology, Hôpital Lariboisière, Assistance Publique‐Hôpitaux de Paris Université Paris Cité Paris FranceDepartment of Cardiology, Hôpital Lariboisière, Assistance Publique‐Hôpitaux de Paris Université Paris Cité Paris FranceDepartment of Cardiology, Hôpital Lariboisière, Assistance Publique‐Hôpitaux de Paris Université Paris Cité Paris FranceDepartment of Cardiology, Hôpital Lariboisière, Assistance Publique‐Hôpitaux de Paris Université Paris Cité Paris FranceAbstract Aims The study aims to assess the in‐hospital and 1 year incremental prognostic value of recent drug abuse use, detected by a systematic urinary screening, in a consecutive cohort of patients hospitalized for acute heart failure (AHF). Methods All patients admitted for AHF with a drug abuse screening using a urinary assay were included in this prospective multicentric study (39 French centres). The outcomes were (i) in‐hospital major adverse cardiovascular events (MACEs) defined as all‐cause death, resuscitated cardiac arrest or cardiogenic shock; and (ii) 1 year MACEs defined as cardiovascular death or hospitalization for AHF. Incremental prognostic value was assessed using the C‐index, the global χ2 and likelihood‐ratio (LR) test, the net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results In total, 458 patients with AHF were included (mean age 68 ± 14 years, 67% male, 79% of new heart failure onset). In‐hospital and 1 year MACEs occurred, respectively, in 65 (14.2%) and 129 (28.2%) patients. Drug abuse detection was independently associated with in‐hospital MACEs [model 1—known comorbidities: odds ratio (OR) = 4.46, 95% confidence interval (CI) (1.88–10.3), P < 0.001; model 2—clinical severity: OR = 3.64, 95% CI (1.56–8.26), P = 0.002], even after propensity‐matched population analysis [OR = 3.34, 95% CI (1.32–8.70), P = 0.011], with a significant incremental prognostic value over and above traditional risk factors (C‐statistic improvement 0.04 with LR test P < 0.001 for both models). Patients with drug abuse detection had worse 1 year survival: HR = 1.82, 95% CI (1.13–2.92), P = 0.012. Drug abuse detection was independently associated with 1 year MACEs after adjustment with traditional prognosticators [OR = 2.54, 95% CI (1.28–4.98), P = 0.008] and propensity‐matched population analysis [OR = 2.77, 95% CI (1.98–5.21), P = 0.001], with an incremental prognostic value as well (C‐statistic improvement 0.02, LR test P < 0.001, positive NRI and IDI). Conclusions Drug abuse use was independently associated with a higher occurrence of both in‐hospital and 1 year MACEs with an incremental prognostic value. These results suggest a potential interest of a systematic illicit drug screening in these patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05063097.https://doi.org/10.1002/ehf2.15118acute heart failuredrug abuseprognostic valueoutcomesdeath |
| spellingShingle | Charles Fauvel Jean‐Guillaume Dillinger Thomas Bochaton Thomas Levasseur Amine El Ouahidi Cyril Zakine Antony El Hadad Nicolas Mansencal Nathalie Noirclerc Marc Goralski Christophe Thuaire Nathan Mewton Guillaume Schurtz Pascal Lim Thibaut Pommier Léo Lemarchand Quentin Laissac Nicolas Lamblin Tanissia Boukertouta Damien Logeart Alain Cohen‐Solal Patrick Henry Théo Pezel for the ADDICT‐ICCU Investigators In‐hospital and 1 year incremental prognostic value of drug abuse detection in acute heart failure ESC Heart Failure acute heart failure drug abuse prognostic value outcomes death |
| title | In‐hospital and 1 year incremental prognostic value of drug abuse detection in acute heart failure |
| title_full | In‐hospital and 1 year incremental prognostic value of drug abuse detection in acute heart failure |
| title_fullStr | In‐hospital and 1 year incremental prognostic value of drug abuse detection in acute heart failure |
| title_full_unstemmed | In‐hospital and 1 year incremental prognostic value of drug abuse detection in acute heart failure |
| title_short | In‐hospital and 1 year incremental prognostic value of drug abuse detection in acute heart failure |
| title_sort | in hospital and 1 year incremental prognostic value of drug abuse detection in acute heart failure |
| topic | acute heart failure drug abuse prognostic value outcomes death |
| url | https://doi.org/10.1002/ehf2.15118 |
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