American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

National Rate of Tobacco and Substance Use Disorders Among Hospitalized Heart Failure Patients

Several cardiotoxic substances impact heart failure incidence. The burden of comorbid tobacco or substance use disorders among heart failure patients is under-characterized. We describe the burden of tobacco and substance use disorders among hospitalized heart failure patients in the United States.


We calculated the proportion of primary heart failure hospitalizations in the 2014 National Inpatient Sample with tobacco or substance use disorders accounting for demographic factors.


Of 989,080 heart failure hospitalizations, 15.5% (n = 152,965) had documented tobacco (n = 119,285, 12.1%) or substance (n = 61,510, 6.2%) use disorder. Female sex was associated with lower rates of tobacco (odds ratio [OR] 0.72; 95% confidence interval [CI], 0.70-0.74) and substance (OR 0.37; 95% CI, 0.36-0.39) use disorder. Tobacco and substance use disorder rates were highest for hospitalizations <55years of age. Native American race was associated with increased risk of alcohol use disorder (OR 1.67; 95% CI, 1.27-2.20) and black race with alcohol (OR 1.09; 95% CI, 1.02-1.16) or drug (OR 1.63; 95% CI, 1.53-1.74) use disorder. Medicaid insurance or income in the lowest quartile were associated with increased risk of tobacco and substance use disorders.


Tobacco and substance use disorders affect vulnerable heart failure populations, including those of male sex, younger age, lower socioeconomic status, and racial/ethnic minorities. Enhanced screening for tobacco and substance use disorders in hospitalized heart failure patients may reveal opportunities for treatment and secondary prevention.

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-Sarah C. Snow, MDa, Gregg C. Fonarow, MDb,c, Joseph A. Ladapo, MD, PhDa, Donna L. Washington, MD, MPHa,d, Katherine J. Hoggatt, PhDd,e, Boback Ziaeian, MD, PhDb,d,f,

-This article originally appeared in the April issue of The American Journal of Medicine.

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