title: Substance abuse at the time of left ventricular assist device implantation is associated with increased mortality.
abstract: BACKGROUND
  Advanced 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.
  
  
  METHODS
  Baseline 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Active 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.
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota. Electronic address: cogsw014@umn.edu.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cogswell
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Elisa
authors.initials: E
authors.lastname: Smith
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Aimee
authors.initials: A
authors.lastname: Hamel
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Lillian
authors.initials: L
authors.lastname: Bauman
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Angela
authors.initials: A
authors.lastname: Herr
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Sue
authors.initials: S
authors.lastname: Duval
authors.affiliation: Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.affiliation: Department of Physical Medicine & Rehabilitation, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Deborah
authors.initials: D
authors.lastname: Roman
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Sirtaz
authors.initials: S
authors.lastname: Adatya
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Monica
authors.initials: M
authors.lastname: Colvin-Adams
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Daniel
authors.initials: D
authors.lastname: Garry
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Cindy
authors.initials: C
authors.lastname: Martin
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Emil
authors.initials: E
authors.lastname: Missov
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Marc
authors.initials: M
authors.lastname: Pritzker
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Justin
authors.initials: J
authors.lastname: Roberts
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Peter
authors.initials: P
authors.lastname: Eckman
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006801:Humans; D020300:Intracranial Hemorrhages / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009102:Multiple Organ Failure / Q000401:mortality; D018805:Sepsis / Q000401:mortality; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000401:mortality / Q000628:therapy*
keywords: heart failure; left ventricular assist device; mortality; outcomes; substance abuse; substance dependence