Rising Number of U.S. Cardiac Arrests Tied to Opioid Abuse

There's been a sharp rise in opioid-related cardiac arrests in the United States and they now equal those associated with other prime causes, a new study finds.

Of more than 1.4 million cardiac arrest hospitalizations nationwide between 2012 and 2018, more than 43,000 (3.1%) occurred in opioid users, and there was a significant increase in opioid-associated cardiac arrest over the seven-year study period, according to a team led by Senada Malik, a medical researcher at the University of New England in Biddeford, Me.

Rates of in-hospital death among cardiac patients were about 57% among opioid users and 61% among those who didn't use opioids, the researchers found.

But certain risk factors were markedly higher in opioid users. For example, the study found that opioid users had higher rates of alcohol abuse (about 17% versus 7%), depression (about 19% vs. 9%) and smoking (37% vs. nearly 22%) than those who didn't use opioids.

The study is to be presented Monday at the virtual annual meeting of the European Society of Cardiology (ESC).

"The rise in opioid-related cardiac arrests during the study period was significant. By 2018, opioids were related to a similar number of cardiac arrests as all other reasons put together," Malik said in an ESC news release.

"This was an observational study so we cannot conclude causality, but the findings do suggest that the opioid epidemic in the U.S. may have contributed to an increasing number of cardiac arrests," Malik added.

According to the study authors, opioid use disorder, which includes dependence and addiction, affects more than 2 million people in the United States, and opioid overdose is the leading cause of death among those ages 25 to 64.

Two experts unconnected to the research said people need to be aware of how opioids can damage the heart.

While cause and effect can't be proven, "it seems that the opioid epidemic in the U.S. during the same time period with higher incidence of risk factors in the affected population contributed to escalating rates of cardiac arrest," said Dr. Sanjey Gupta, who directs emergency medicine at South Shore University Hospital in Bay Shore, N.Y.

Dr. Guy Mintz is Northwell Health's director of cardiovascular health at the Sandra Atlas Bass Heart Hospital in Manhasset, N.Y. He said the findings may come as a surprise -- and a warning -- to people who abuse opioid drugs.

"Most people hear opioid overdose and worry about addiction," Mintz said. "People need to be made aware of the real dangers of opioids. The fact that opioids are associated with an increased risk of cardiac arrest and [a majority] of those patients die is important for people to know."

Behind the numbers lie real tragedies for families wrestling with problematic drug use, Mintz added.

"I had a case of a 19-year-old boy who had a [heart attack] after using cocaine at his brother's bachelor party -- he had to be put on the heart transplant list," Mintz noted. "Opioids can cause spasm of the coronary arteries, rapid heartbeat and elevated blood pressure. It is no surprise to me that cardiac arrest and death rates are high after use."

Study author Malik agreed.

"The rising use of opioids is having a devastating impact on the lives of many Americans," she said. "Abuse of these drugs has been linked with poor lifestyle choices including excessive alcohol intake, lack of exercise, insufficient sleep and smoking -- which can lead to a downward spiral of poor decision-making."

Mintz said better education of the threat is crucial.

"Society needs to improve education, counseling and get this message out loud and clear to school-age children, and [it should be] reinforced in middle school and high school," he said. "Failure to do so will contribute to the number of cardiac arrests and death. The choice is ours."

Because the findings were presented at a medical meeting, they should be considered preliminary until published in a peer-reviewed journal.