Substance Use and Cardiac Implantable Electronic Devices: A Single Institution Analysis of Re-Hospitalization, Follow-Up Rate, and Complications to Predict Patient Outcomes.

Introduction Illicit drug use is a prevalent issue in Phoenix, Arizona, and is associated with various health concerns, including disrupting the conduction system of the heart. Cardiac implantable electronic devices (CIEDs), such as pacemakers and cardioverter-defibrillators, are common treatment options for conduction abnormalities. However, there is ongoing debate regarding the implantation of CIEDs in patients reporting active substance use, hypothesized to stem from provider concerns around lead endocarditis and poor follow-up adherence. Currently, information in the literature regarding outcomes of CIED patients with active substance use is lacking. This study aims to bridge this gap through evaluating differences in rehospitalization, follow-up, and CIED-related complications among patients with and without current substance use. Methods Patient records between January 2020 and December 2024 of those who received care at Valleywise Health in Phoenix, Arizona, were reviewed. All patients with complete records who had a CIED were included in the study. Covariates included patient demographics, substance use status, comorbidities, problems with CIED (infection, malfunction, adjustment/reprogramming), number of encounters, rehospitalization rates at 30 days, 90 days, and one year, and office follow-up rates. Continuous variables were compared between substance use statuses using the independent T-test or the Wilcoxon Rank Sum. Categorical variables were compared using the chi-squared analysis. Odds ratios (95% CI) were calculated using logistic regression to assess the association between substance use status, rehospitalization, and office follow-up while adjusting for potential confounding variables. Logistic regression modeling was repeated following a propensity score match to create comparable cohorts between patients with and without current substance use. Results A total of 2,522 patients were included in the study, with 90.4% reporting no current substance use and 9.64% reporting current substance use. There were no differences in 30-day, 90-day, and one-year rehospitalizations between patients with current substance use and patients with no substance use. There was also no difference in follow-up rates between these groups. In the unmatched analysis, Hispanic/Latino patients were less likely to have 30-day, 90-day, and one-year rehospitalizations compared to non-Hispanic/Latino patients. In the matched analysis, this was no longer significant. Additionally, in the unmatched analysis, patients reporting no substance use had more device malfunctions, adjustments, and infections compared to patients with current substance use. This difference was not seen following the propensity score match. Finally, patients who were unhoused were 23-fold (unmatched analysis) and 33-fold (matched analysis) more likely to have office follow-ups compared to housed patients. Conclusion This study demonstrated a lack of statistical difference in rehospitalizations and follow-ups between patients with CIEDs with and without substance use. This study also demonstrated that patients with CIEDs and current substance use were not at an increased risk for device infections or malfunctions compared to patients without current substance use. Further studies are necessary with larger populations to validate these conclusions.