Trends and Influence of Substance Use On Hospital Outcomes of Patients With Pulmonary Hypertension: A National Inpatient Sample-Based Study

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

Chest

Abstract

PURPOSE: There is minimal evidence available about influence of substance use on hospital outcomes even in the general population, with the majority focusing on tobacco, alcohol, and opioid use. While opioids, methamphetamine, and cocaine have been identified as potential causes of pulmonary arterial hypertension (PAH), it remains unclear if concurrent substance use in patients with any type of pulmonary hypertension can significantly alter hospital course and outcomes. We aimed to study hospitalized pulmonary hypertension patients for 10-year time-trends of substance use, time-trend of hospital outcomes in this group and compare it to non-substance users. METHODS: An ecological time-trend study using 10-year data (2011-2020) from the National Inpatient Sample (NIS) was conducted. Adults (>18 years) with a primary diagnosis of pulmonary hypertension (all types) and documented substance use of tobacco, cannabis, cocaine, opioids, and alcohol were identified using the International Classification of Diseases (ICD)-9 and 10 codes. Outcomes were inpatient mortality, hospital length of stay, total hospital charges, and disposition. For analysis, SAS 9.4 was used to perform Cochran-Armitage trend tests, Rao-Scott design-adjusted chi-square test for categorical variables, and F statistics from linear regression for continuous variables. A p-value of #0.05 was significant. RESULTS: During 2011 to 2020, 62,020 patients were identified with pulmonary hypertension of which 5,259 had substance use documented and the rest 56,761 were non-users. Time-trends of cannabis (0.56% to 1.32%), cocaine (0.60% to 0.96%), and opioid (1.23 to 1.92%) use significantly increased, while tobacco (7.76% to 1.08%) and alcohol (4.73% to 4.32%) use declined. The time-trend of mortality significantly increased in opioid users (0 to 9.38%) and decreased in alcohol users (18.07% to 6.94%). Time-trend of total hospital charges increased only for alcohol users (63,472 to 92,159 USD). Against medical advice (AMA) discharges significantly uptrended for opioid users (0 to 6.25%) over time. Mean age of substance users (55.7 years) was significantly lower to non-users (64.19 years). Remarkably, inpatient mortality (5.34% vs 2.92%), length of stay (6.73 vs 6.55 days), and total hospital charges (87,749 vs 76,546 USD) were all significantly higher for non-users than users. CONCLUSIONS: While a positive impact of growing awareness on smoking and alcohol cessation is reflected, illicit drug use increased over the years. The rising trend in opioid use has had the most deleterious impact on hospital outcomes including inpatient mortality and nonadherent care (AMA discharges), further emphasizing the need for opioid stewardship in healthcare. Contrary to our belief, hospitalized non-substance users had worse overall outcomes than substance users. However, given that the most common etiology of pulmonary hypertension is left heart disease, the higher mean age in non-users suggests a possible role of increasing comorbidities with age and their interactions to have contributed to these findings. Coding errors and misclassification, missing data, unmeasured confounding and inability to establish causality remain our limitations. Further studies are recommended to establish association. CLINICAL IMPLICATIONS: Role of substance use in pulmonary hypertension is under-studied. This study emphasizes the potential effect of substance use, specifically opioids, on negative hospital outcomes, especially in a younger population with pulmonary hypertension.

Volume

168

Issue

4S

First Page

6629A

Last Page

6630A

Comments

American College of Chest Physicians CHEST Annual Meeting, October 19-22, 2025, Chicago, IL

DOI

10.1016/j.chest.2025.07.3712

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