Trends in urine drug screening and positivity among patients with heart failure: Insights from a large health system

Background: Substance use is common in patients with HF and affects candidacy for advanced HF therapies. Rates and results of urine drug screening (UDS) are understudied particularly in the setting of increasing decriminalization of some substances. Substance use, particularly cannabis, has been increasing in older age groups who are most at risk of HF. However, while UDS assesses substance use, no guidelines recommend routine screening for patients with HF, outside of evaluation for advanced therapies. Methods: We performed a retrospective study including data from the Epic electronic health record of a large academic health system in Colorado. We identified 75,166 adult patients who had a UDS, of which 6,725 (8.9%) had HF or cardiomyopathy. Results: Among patients with a UDS, any positive result was found in 64.6% for patients with HF and 56.0% for patients without HF. For patients with HF who had a UDS, the highest positivity rates were for opiates (42.4%), cannabinoids (29.0%), benzodiazepines (28.0%), and cocaine (11.0%). Patients who were tested with UDS were more likely to have HF if they were older, male, Black and were Medicare beneficiaries. Our analysis demonstrated a high rate of UDS positivity among patients presenting with HF who were tested for UDS in a tertiary care center. Conclusion: Conclusion: Findings suggest that substance use, particularly opioids and cannabinoids, may be common in patients with HF.