The American Heart Association (AHA) has issued a Presidential Declaration containing recommendations and considerations for managing the effects of opioids on cardiovascular and neurovascular health. 1
National opioid abuse statistics are grim. In 2018, over 67,000 people died from drug overdoses, two-thirds of them related to opioids. Although the death toll was slightly down from 2017, that improvement was offset in 2020 due to COVID-19. The Centers for Disease Control and Prevention estimates that the number of deaths from overdose in 2020 was over 92,000
On behalf of the AHA, a committee of leading health authorities developed this statement in response to the growing epidemic and as a guide to opioid abuse in relation to patients with cardiovascular disease and stroke. The recommendations and suggestions / considerations were based on evidence from a literature search of epidemiological studies, review articles, consensus statements and guidelines as well as expert opinions.
Acute pain management in patients with cardiovascular diseases
In order to reduce the use of opioids in patients with cardiovascular diseases and to prevent harmful drug interactions, the AHA has made the following suggestions / considerations for acute pain therapy:
- Acetaminophen, aspirin, and non-acetylated salicylates should be considered as alternatives to opioids for treating pain in patients with cardiovascular disease and muscle or joint pain.
- The use of morphine in patients with acute coronary syndrome (ACS) may reduce the effectiveness of P2Y12 receptor antagonists.
- Morphine can be used in moderation to relieve pain and anxiety in patients who experience persistent pain despite alternative treatment approaches.
- For hospitalized patients with ACS, clinicians may consider co-administering parenteral platelet inhibitors with morphine.
CPR guidelines for suspected opioid overdose
In its CPR guidelines for providing basic life support to a person suspected of having an opioid overdose, the AHA emphasized activating 911 and initiating chest compressions prior to administration of naloxone. Emergency assistance should be requested immediately as determining the cause of the cardiac arrest can be difficult, especially for the layperson, and naloxone would only be effective if the cardiac arrest was caused by an opioid overdose.
Needle exchange programs to reduce the risk of infectious endocarditis
Infectious endocarditis can be transmitted through needles that are shared and used to inject opioids. The opioid epidemic has led to an increase in hospital admissions for infectious endocarditis and related strokes. The AHA recommends expanding free syringe exchange programs to reduce the risk of infectious endocarditis.
Combating the opioid epidemic
Strategies to combat opioid abuse should be put in place at all levels.
- In the health care workforce, professionals managing pain in cardiovascular and stroke situations should receive training in opioid-free pain management and identifying patients with opioid use disorders. The AHA also calls for destigmatizing treatment for opioid use disorders.
- Other employers are encouraged to adopt evidence-based policies and strategies to combat the opioid pandemic.
- Federal, state, and local health and law enforcement agencies should take a coordinated approach to tackling opioid abuse.
- Research is needed to better understand the biology of addiction and to develop more effective therapies. In patients with cardiovascular disease, there are gaps in knowledge of the use of non-opioid alternatives to pain management, cardiovascular manifestations of opioid withdrawal, and alternative approaches to treating pain and anxiety in cardiovascular emergencies.
- Chow SL, Sasson C, Benjamin IJ, et al .; on behalf of the American Heart Association. Opioid use and its relationship to cardiovascular disease and brain health: a recommendation from the President of the American Heart Association. Traffic. Published online August 19, 2021. doi: 10.1161 / CIR.0000000000001007.
2. US Centers for Disease Control and Prevention (CDC). Preliminary deaths from drug overdose. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm. Updated August 1, 2021. Accessed August 17, 2021
This article originally appeared on The Cardiology Advisor