Study Warns of Increased Incidence, Risk of Death with Arrhythmias in Cannabis Users

Sittinun Thangjui, MD

Researchers hope the results of their latest study will serve as a warning for heightened awareness around cannabis use and increased risk of mortality among patients with certain cardiovascular conditions.

An analysis of more than 2 million cannabis users within the US suggests those with arrhythmia were 4.5 times more likely to die during hospitalization than those without an arrhythmia.

"Our study highlights that heart rhythm disorders may be a warning sign for an increased risk of death in people who use cannabis. More studies are needed to confirm our results. In the meantime, it seems sensible to screen these patients for arrhythmias if they present to hospital so that those with a heart rhythm problem can be closely monitored,” said Sittinun Thangjui, MD, an internal medicine resident at Bassett Healthcare Network in Cooperstown, New York, in a statement.

With the popularity of recreational and medicinal cannabis at an all-time high and expected to grow, a greater understanding of associations between cannabis use and cardiovascular health could impact care for thousands, if not millions of patients in the future. The current study, which was presented at European Heart Rhythm Association (EHRA) Congress 2021, sought to determine the prevalence of different types of arrhythmia in hospitalizations associated with cannabis use disorder.

To do so, Thangjui and a team of colleagues performed a search of the National Inpatient Sample (NIS) databases from January 2016-December 2018 to identify adult hospitalizations with a diagnosis of cannabis use related disorders. After identifying these patients, ICD-190 codes were used to identify diagnoses of arrhythmias.

From the NIS databases, investigators also obtained data related to confounders including age, sex, race, diabetes, heart failure, chronic kidney disease, anemia, obesity, Elixhauser comorbidity index, hospital location, teaching status, bed size, and income status, among others. For the purpose of analysis, investigators used the Chi-square test to evaluate the differences between binary or categorical variables, and Student’s t-test for continuous variables.

From their search, investigators identified 2,457,544 hospitalizations associated with cannabis use related disorders during the study period. Of these, 7.6% (n=187,825) were associated with any arrhythmia. Among those with arrhythmias, atrial fibrillation was the most common—appearing in more than 40% of patients.

In comparison to those without arrhythmia, patients with arrhythmia had a greater mean age (50.5 vs 38.3 years; P <.01) and had higher co-morbidity (% with Elixhauser comorbidity score greater than 3: 94.1% vs 60.6%; P< .01). In adjusted models, investigators found the arrhythmia group was associated with increased odds of in-hospitality mortality when compared against the non-arrhythmia group (OR, 4.5; 95% CI, 4.09-5.00; P <.01). Additionally, patients with any arrhythmia had a statistically significant increase in hospitalization length of stay (5.7 vs 5.1 days; P <.01).

“People should be aware of this devastating outcome and be careful when using cannabis if they have a concomitant heart problem," added Thangjui.

This study, "Burden of arrhythmia in hospitalized patients with cannabis use related disorders: analysis of 2016-2018 national inpatient sample,” was presented at EHRA 2021.