Frequently hospitalized patients are a large burden to the healthcare system, both in terms of hospital days and cost. For many patients, this is due to the severity of their underlying medical comorbidities. However, other patients may be driven to seek care due to comorbidities such as chronic pain and/or mental health disorders. This study sought to characterize the relationship between the presence of chronic pain and mental health disorders with mortality for the cardiac comorbidities of congestive heart failure (CHF) and coronary artery disease (CAD).
During a six month period, we identified all patients age 18 and older (n = 153) who had four or more unscheduled admissions to inpatient General Medicine and Medicine Specialty services at a large academic hospital. Scheduled admissions were excluded, as were admissions to nonmedical services (e.g. surgery). Data regarding the presence of chronic pain/narcotic dependence and mental health disorders was collected. Chi square analysis was used to calculate measures of association in form of relative risk (RR) of mortality. Statistical significance was assessed by selecting for patients with the given comorbidity and comparing risk of twoyear mortality in those with and without chronic narcotic dependence. Fisher’s exact test was used to help assess whether these were effect modifiers. Significance was assessed by measuring 95% confidence intervals and twosided Chi square values with twotailed p values.
A high prevalence of chronic narcotic dependence and mental health disorders was shown by these data. To evaluate whether chronic narcotic dependence or mental health disorders were effect modifiers as hypothesized, the mortality risk was evaluated for CHF and CAD and interaction was assessed through stratification. The differences in mortality rates for those with and without chronic pain were suggestive of lower risk in those with chronic pain. These mortality differences were significant in those with CHF (26.3% vs 60.9%, p = 0.026) and CAD (14.3% vs 50.0%, p = 0.027). Similar analysis of those with and without comorbid mental health disorders was not suggestive of a trend.
The increased risk of mortality from CAD and CHF were modified by the presence of chronic narcotic dependence, and these differences were statistically significant. Often patients with chronic narcotic dependence seek care for exacerbation of their chronic pain, versus for worsening of their underlying cardiac disease as is seen more often in those without chronic pain. Similarities between the CHF and CAD populations can easily be attributed to the fact that most people with CHF have comorbid CAD. Similar trends were not found in those with comorbid mental health disease.
To cite this abstract:Dastidar J, Jiang M. Effect Modification of Chronic Narcotic Dependence in Frequently Hospitalized Patients with Comorbid Cardiac Disease. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97636. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/effect-modification-of-chronic-narcotic-dependence-in-frequently-hospitalized-patients-with-comorbid-cardiac-disease/. Accessed September 17, 2019.