Heart patients prescribed opioids at hospital discharge often fare worse

Heart disease patients prescribed opioids at hospital discharge were less likely to follow up with their healthcare provider or to participate in heart rehabilitation than patients who were not, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

As the nationwide opioid epidemic continues, the risks versus benefits of these strong painkillers are being questioned. Previous research found health problems among patients prescribed opioids for non-cancer-related pain and a recent study linked opioid use to an increase risk of atrial fibrillation.

In this study, researchers analyzed 2,495 patients (mostly white males; average age 60) discharged from Vanderbilt University Medical Center for heart attack, sudden heart failure, or both between October 2011 and December 2015. Twenty percent of patients were discharged with an opioid prescription.

Compared to those not prescribed opioids at discharge, researchers found patients prescribed opioids were:

• less likely to follow up with their healthcare provider or participate in heart rehabilitation thirty days after discharge; and
• slightly more likely to visit the emergency room, be readmitted to the hospital, or to die within 90 days.

"Hospital discharge provides a unique opportunity to evaluate each patient's medication regimen," said study lead author Justin S. Liberman, M.D., M.P.H., assistant professor of anesthesiology at Vanderbilt University Medical Center in Nashville, Tennessee. "It's important for healthcare providers to understand the other ways that opioids may affect a patient's future interactions with the healthcare system."

Researchers reviewed patients' medical records through the Vanderbilt Inpatient Cohort Study. After hospital discharge, participants provided information by telephone interview about their use of medical services. Interviews occurred 2-3 days, 30 days and 90 days after discharge.

The study shows an association but does not prove that opioid prescriptions caused patients to miss follow-up care. Researchers said, it's possible that diminished physical and mental function, known effects of opioids, contributed.

The study may be limited by a lack of information about the number of opioids taken and their duration of use. Also, the study focused on one hospital with a primarily white population and may not apply to others.