Medication Post-Alcohol-Related Hospitalization Discharge Reduces Death Risk

Eden Y. Bernstein, MD

Credit: Harvard T.H. Chan

A new study found prescribing alcohol use disorder medications after alcohol-related hospitalizations reduces the risk of rehospitalization or death within 30 days. Taking the medication lowers the risk by 18%.¹

Alcohol use disorder affects 29 million adults and creates an economic burden of ≥ $250 billion. Although the US Food and Drug Administration (FDA) approved medications for alcohol use disorder, they are “significantly underused,” with ≤ 2% of US adults receiving these medications in 2019.

“These therapies are evidence-based, inexpensive, and have manageable side effects,” investigator Timothy Anderson, MD, from the University of Pittsburgh, said in a press release.²

Since not many studies examined the clinical outcomes of patients taking medications for alcohol use disorder after their discharge, a new retrospective cohort study, led by Eden Y. Bernstein, MD, from Massachusetts General Hospital and Harvard Medical School, sought to assess the link between taking medications for alcohol use disorder following a discharge and the 30-day post-hospitalization outcomes.¹ Investigators leveraged data from 20% of the national sample of Centers for Medicare and Medicaid services administrative and pharmacy claims from 2015 to 2017.

Participants all had Medicare Part D and alcohol-related hospitalizations in 2016. For people who were prescribed alcohol use disorder medications, this was defined as oral naltrexone, acamprosate, or disulfiram pharmacy fills within 2 days of discharge.

The primary outcome was the number of all-cause mortality or return to hospital—including emergency department visits and hospital readmissions within 30 days of discharge. The secondary outcomes included the primary outcome components individually, return to the hospital for alcohol-related diagnoses, and a primary care or mental health follow-up within 30 days of discharge. Investigators analyzed the data from October 2022 to December 2023.

Participants (n = 6794) who received and did not receive discharge alcohol use disorder medication were matched 3:1. In total, there were 9834 alcohol-related hospitalizations with a median age of 54 years (46 – 62 years), and 32.6% females had alcohol-related hospitalizations. White people had the most hospitalizations (71.8%), followed by Black (18.8%) and Hispanic (7.2%). Of the hospitalizations, 2% (n = 192) ended with initiating medication for alcohol use disorder following discharge, including the medications naltrexone (58.3%), acamprosate (27.6%), and disulfiram (16.7%).

Investigators found taking the alcohol use disorder medication after the discharge was linked to a 42% decreased incidence of both all-cause mortality and rehospitalization (incident rate ratio [IRR], 0.58; 95% confidence interval [CI], 0.45 to 0.76; absolute risk difference [ARD], - 0.18; 95% CI, -0.26 to -0.11). Adjusted models also showed medication was linked to a reduced incidence of all-cause emergency department visits (IRR, 0.57; 95% CI, 0.41 to 0.80; ARD, -0.13; 95% CI, - 0.20 to -0.06) and all-cause readmissions (IRR, 0.42; 95% CI, 0.27 to 0.63; ARD, -0.16; 95% CI, -0.22 to -0.10). However, the team saw no significant difference in mortality due to how rare it was (IRR, 3.00; 95% CI, 0.42 to 21.22; ARD, 0.01; 95% CI, -0.01 to 0.02).

The team found starting medication after the discharge was associated with a 51% decreased incidence of alcohol-related return to the hospital (IRR, 0.49; 95% CI, 0.34 to 0.71; ARD, -0.15; 95% CI, -0.22 to -0.09) when looking at this outcome separate from mortality.

Less than half of the hospitalizations (43.6%) had a 30-day primary care or mental health follow-up and having medication after the discharge was linked to the increased incidence of this outcome (IRR, 1.22; 95% CI, 1.04 to 1.44; ARD, 0.10; 95% CI, 0.02 to 0.18).

“Given the potential upsides demonstrated in this study, training inpatient clinicians to initiate these medications and to develop plans for post-hospital follow-up with patients and their primary care team has the potential to improve patient outcomes and to reduce preventable readmissions,” Anderson said.²

Investigators addressed several limitations, including the observational study design, an unmeasured confounding—such as not accounting for healthy user bias or psychosocial factors like patient motivation—being unable to tell alcohol use disorder severity, unable to identify rates of long-acting injectable naltrexone that was started at the hospital due to inpatient billing, not being able to identify the use of nonpharmacologic treatment, and the 2016 data might not be representative of outcomes in 2024.¹

“Our findings highlight the potential clinical benefit associated with increased uptake of these medications in this setting and suggest a need to support and expand ongoing efforts to improve access to these medications upon hospital discharge,” Bernstein said in the press release.²

^References

1. ^{Bernstein EY, Baggett TP, Trivedi S, Herzig SJ, Anderson TS. Outcomes After Initiation of Medications for Alcohol Use Disorder at Hospital Discharge. JAMA Netw Open. 2024;7(3):e243387. Published 2024 Mar 4. doi:10.1001/jamanetworkopen.2024.3387}
2. ^{Study Finds Benefits in Prescribing Alcohol Use Disorder Medications Upon Discharge from Alcohol-Related Hospitalizations. EurekAlert! March 29, 2024. https://www.eurekalert.org/news-releases/1039588. Accessed April 5, 2024.}