Congestive Heart Failure Hospitalizations and Cannabis Use Disorder (2010-2014): National Trends and Outcomes

Background and objectives: Prior studies have suggested that cannabis use is an independent risk factor for heart failure. With increasing recreational use of cannabis and decriminalization policies, cannabis use is expected to add to the burden of heart failure, but there is still limited data. Therefore, we utilized the Nationwide Inpatient Sample (NIS) database (2010-2014) to study the national trends and outcomes among cannabis users admitted for congestive heart failure (CHF).

Methods: We queried the NIS database and identified CHF as the primary diagnosis with a co-diagnosis of cannabis use disorder (CUD). Trends were analyzed with the linear-by-linear association.

Results: Total CHF admissions (N = 4,596,024) with comorbid CUD (N = 23,358 (0.5%)) were identified. An increasing prevalence trend from 0.4% to 0.7% (P= 0.001) was seen. CUD patients had a mean age of 49.78 years, 79% were males, 55.4% were African Americans, and 73.6% earn ≤ 50th percentile median household income of the patient's ZIP code. Inpatient deaths (1.1% vs. 3.1%) were lower (P<0.001), and mean length of stay (LOS) was shorter among cannabis users compared to non-users (P=0.001). The mean LOS and total hospitalization costs demonstrated an increasing trend (P_trend = 0.001 and P_trend < 0.001) respectively. Alcohol abuse and depression were more prevalent among CUD compared to non-CUD patients.

Conclusion: CUD was associated with reduced inpatient deaths, but the prevalence of CUD and hospital charges is on the rise in the CHF inpatient population in addition to shorter mean LOS. Notwithstanding, these above findings prompt further research into its underlying mechanisms along with a probable causal relationship between cannabis and heart failure.

Keywords: cannabis use disorder; congestive heart failure; length of stay; marijuana; mortality; trends.