Prevalence of psychoactive drug use in patients hospitalized for acute cardiac events

Prevalence of psychoactive drug use in patients hospitalized for acute cardiac events: Rationale and design of the ADDICT-ICCU trial, from the Emergency and Acute Cardiovascular Care Working Group and the National College of Cardiologists in Training of the French Society of Cardiology

Jean-Guillaume Dillinger, Théo Pezel, Charles Fauvel, Clément Delmas, Guillaume Schurtz, Antonin Trimaille, Edouard Gerbaud, Vincent Roule, Jean-Claude Dib, Albert Boccara, Damien Millischer, Christophe Thuaire, Julien Fabre, Thomas Levasseur, Tanissia Boukertouta, Arthur Darmon, Ruben Azencot, Benoit Merat, Marie Haugel-Moreau, Alain Grentzinger, Clément Charbonnel, Cyril Zakine, Marc Bedossa, Benoît Lattuca, François Roubille, Victor Aboyans, Etienne Puymirat, Ariel Cohen, Eric Vicaut, Patrick Henry, for the ADDICT-ICCU
investigators

Background: Psychoactive drugs, including illicit drugs, are associated with an increased rate of cardiovascular events. The prevalence and outcome of patients using these drugs at the time of admission to an intensive cardiac care unit is unknown.

Aim: To assess the prevalence of psychoactive drugs detected in consecutive patients hospitalized in an intensive cardiac care unit for an acute cardiovascular event.

Methods: This is a nationwide prospective multicentre study, involving 39 centres throughout France, including all consecutive patients hospitalized in an intensive cardiac care unit within 2 weeks. Psychoactive drug use will be assessed systematically by urine drug assay within 2 hours of intensive cardiac care unit admission, to detect illicit (cannabinoids, cocaine, amphetamines, ecstasy, heroin and other opioids) and non-illicit (barbiturates, benzodiazepines, tricyclic antidepressants, methadone and buprenorphine) psychoactive drugs. Smoking will be investigated systematically by exhaled carbon monoxide measurement, and alcohol consumption using a standardized questionnaire. In-hospital major adverse events, including death, resuscitated cardiac arrest and cardiogenic shock, will be recorded. After discharge, all-cause death and major adverse cardiovascular events will be recorded systematically and adjudicated at 12 months of follow-up.

Results: The primary outcome will be the prevalence of psychoactive drugs detected by systematic screening among all patients hospitalized in an intensive cardiac care unit. The in-hospital major adverse events will be analysed according to the presence or absence of detected psychoactive drugs. Subgroup analysis stratified by initial clinical presentation and type of psychoactive drug will be performed.

Conclusions: This is the first prospective multicentre study to assess the prevalence of psychoactive drugs detected by systematic screening in consecutive patients hospitalized for acute cardiovascular events.