Substance Use Disorder and Acute Myocardial Infarction Readmissions After Heart Failure Hospitalization: A Nationwide Analysis of 31.9 Million U.S. Hospitalizations

Authors

Keywords:

Heart Failure, Substance-Related Disorders, Myocardial Infarction, Patient Readmission, Cannabis

Abstract

Background

Prior work identified substance use disorder (SUD) as the only psychiatric comorbidity independently associated with increased cardiovascular (CV) readmission risk after heart failure (HF) hospitalization. This study aims to characterize the clinical profile of HF patients with co-occurring SUD; identify the CV diagnoses associated with the greatest risk of readmission; and compare short- and long-term readmission patterns.

Methods

We conducted a retrospective cohort study using the 2016-2022 Nationwide Readmissions Database and included adults hospitalized for HF with and without SUD. The primary outcomes were the CV diagnoses associated with the greatest risk of readmission at 30 days and 1 year. A secondary, substance-specific analysis stratifying SUD into individual substance categories was performed to assess their associations with myocardial infarction (MI) readmission.

Results

Among 31,886,859 HF hospitalizations, acute MI conferred the greatest SUD-associated risk of CV readmission at both 30 days (aHR 1.16) and 1 year (aHR 1.14). Cannabis (aHR 1.21 at 30 days; 1.22 at 1 year) and other stimulant use, including amphetamine or methamphetamine (aHR 1.26 at 30 days; 1.27 at 1 year) yielded the highest sustained MI readmission risk. Cocaine emerged as an additional risk factor at 1 year (aHR 1.17). p<.001 for all.

Conclusion

Acute MI is the most clinically consequential CV readmission diagnosis among HF patients with SUD. The excess risk is driven primarily by cannabis and stimulant use, with cocaine contributing longer-term risk. These findings highlight the need for integrated CV and addiction-focused care pathways to reduce preventable ischemic events in this high-risk population.

Author Biography

Michael D. White, MD, Creighton University School of Medicine & Valleywise Health Medical Center

Department of Cardiology, Valleywise Health Medical Center, Phoenix, Arizona, USA

Executive Vice President & Chief Clinical Officer, Valleywise Health

Associate Professor, Creighton University School of Medicine

References

1. Wei C, Heidenreich PA, Sandhu AT. The economics of heart failure care. Prog Cardiovasc Dis. 2024;82:90-101.

2. Urbich M, Globe G, Pantiri K, Heisen M, Bennison C, Wirtz HS, et al. A systematic review of medical costs associated with heart failure in the USA (2014–2020). Pharmacoeconomics. 2020;38:1219-36.

3. Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 alcohol use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015;72(8):757-66.

4. Spencer MR, Garnett MF, Miniño AM. Drug overdose deaths in the United States, 2002–2022. NCHS Data Brief. 2024;491:1-8.

5. Munipalli B, Al-Soleiti M, Morris A, Rummans T. COVID-19: Ramifications of the pandemic on mental health and substance abuse. Front Public Health. 2024;12:1401734.

6. Minhas AMK, Kewcharoen J, Hall ME, Warraich HJ, Greene SJ, Shapiro MD, et al. Temporal trends in substance use and cardiovascular disease-related mortality in the United States. J Am Heart Assoc. 2024;13:e030969.

7. Glynn P, Lloyd-Jones DM, Feinstein MJ, Carnethon M, Khan SS. Disparities in cardiovascular mortality related to heart failure in the United States. J Am Coll Cardiol. 2019;73(19):2354-55.

8. Dickson SD, Thomas IC, Bhatia HS, Nishimura M, Mahmud E, Tu XM, et al. Methamphetamine-associated heart failure hospitalizations across the United States: geographic and social disparities. J Am Heart Assoc. 2021;10(7):e018370.

9. Thurmann KE, Mukherjee TG, Dantin JG, Kang PT, White MD. Associations between psychiatric comorbidities and cardiovascular readmissions in heart failure: a nationwide analysis with a focus on substance use disorder. Cureus. 2025;17:e86933.

10. Boarescu I, Boarescu PM. Drug-induced myocardial infarction: a review of pharmacological triggers and pathophysiological mechanisms. J Cardiovasc Dev Dis. 2024;11(12):406.

11. Healthcare Cost and Utilization Project (HCUP). Overview of the Nationwide Readmissions Database (NRD). Rockville, MD: Agency for Healthcare Research and Quality; 2022. Available from: https://www.hcup-us.ahrq.gov/nrdoverview.jsp.

12. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383.

13. Kim ST, Park T. Acute and chronic effects of cocaine on cardiovascular health. Int J Mol Sci. 2019;20(3):584.

14. Golaszewska A, Misztal T, Marcinczyk N, Chabielska E, Rusak T. Adrenaline may contribute to prothrombotic condition via augmentation of platelet procoagulant response, enhancement of fibrin formation, and attenuation of fibrinolysis. Front Physiol. 2021;12:657881.

15. Kevil CG, Goeders NE, Woolard MD, Bhuiyan MS, Dominic P, Kolluru GK, et al. Methamphetamine use and cardiovascular disease: in search of answers. Arterioscler Thromb Vasc Biol. 2019;39(9):1739-46.

16. Perrine SA, Michaels MS, Ghoddoussi F, Hyde EM, Tancer ME, Galloway MP. Cardiac effects of MDMA on the metabolic profile determined with 1H-magnetic resonance spectroscopy in the rat. NMR Biomed. 2009;22(4):419-425.

17. Latif Z, Garg N. The impact of marijuana on the cardiovascular system: a review of the most common cardiovascular events associated with marijuana use. J Clin Med. 2020;9(6):1925.

18. Baskaran J, Narayanan MA, Vakhshoorzadeh J, Ahmad A, Bertog S. Marijuana-induced coronary vasospasm with persistent inter-coronary connection: a case report and review of literature. Cureus. 2019;11(6):e4799.

19. Dahdouh Z, Roule V, Lognoné T, Sabatier R, Grollier G. Cannabis and coronary thrombosis: what is the role of platelets? Platelets. 2012;23(4):243-45.

20. Jeffers AM, Glantz S, Byers AL, Keyhani S. Association of cannabis use with cardiovascular outcomes among US adults. J Am Heart Assoc. 2024;13(3):e030178.

21. Hadi HAR, Carr CS, Al Suwaidi J. Endothelial dysfunction: cardiovascular risk factors, therapy, and outcome. Vasc Health Risk Manag. 2005;1(3):183-98.

22. Brien SE, Ronksley PE, Turner BJ, Mukamal KJ, Ghali WA. Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies. BMJ. 2011;342:d636.

23. Rimm EB, Williams P, Fosher K, Criqui M, Stampfer MJ. Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. BMJ. 1999;319(7224):1523-28.

24. Wong GTC, Huang Z, Ji S, Irwin MG. Remifentanil reduces the release of biochemical markers of myocardial damage after coronary artery bypass surgery: a randomized trial. J Cardiothorac Vasc Anesth. 2010;24(5):790-6.

25. Carr S, Bryazka D, McLaughlin SA, Zheng P, Bahadursingh S, Aravkin AY, et al. A burden of proof study on alcohol consumption and ischemic heart disease. Nat Commun. 2024;15:4082.

26. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720-3826. Correction in: Eur Heart J. 2024;45(12):1145.

27. Minozzi S, Saulle R, De Crescenzo F, Amato L. Psychosocial interventions for psychostimulant misuse. Cochrane Database Syst Rev. 2016;9:CD011866.

28. Caulkins JP. Changes in self-reported cannabis use in the United States from 1979 to 2022. Addiction. 2024;9(9):1648-52.

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Published

2026-10-08

How to Cite

Thurmann, K., Charles, A., Ernst, P., Mukherjee, T., Kang, P., & White, M. (2026). Substance Use Disorder and Acute Myocardial Infarction Readmissions After Heart Failure Hospitalization: A Nationwide Analysis of 31.9 Million U.S. Hospitalizations. International Journal of Medical Students. Retrieved from https://ijms.pitt.edu/IJMS/article/view/4237

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Copyright (c) 2026 Kyle E. Thurmann, MS, Austin A. Charles, Peter L. Ernst, Trisha G. Mukherjee, Paul T. Kang, MS, MPH, Michael D. White, MD

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