Prevalence and Impact of Substance Use on Hospitalization and Post-Discharge Outcomes in Individuals with Congestive Heart Failure: Findings from a Safety-Net Hospital.

Introduction: Congestive heart failure (CHF) is a major global health challenge and the leading cause of hospitalization in the U.S., with disproportionately high 30-day readmission rates among low-income and minority communities. Social drivers of health and substance use both influence CHF outcomes, yet the effect of substance use on short-term readmissions remains understudied. This study evaluated the association between substance use and all-cause 30-day readmissions at a Safety-Net Community Hospital. Methods: A retrospective chart review was conducted among 500 adults admitted with CHF between 2019 and 2021. Substance use was defined as any documented use, identified through a positive urine toxicology or patient-reported social history of cocaine, tetrahydrocannabinol (THC), opioids, amphetamines, benzodiazepines, barbiturates, methadone, or phencyclidine (PCP). Alcohol and tobacco were assessed separately. Group differences were assessed using Chi-square and Wilcoxon rank-sum tests. Multivariable logistic regression was used for 30-day readmissions, and multivariable Poisson regression was used for total hospitalizations and length of stay (LOS). Results: Evidence of substance use was present in 38% of patients, with cocaine and THC most common. Patients with a history of substance use were younger, more often male, and experienced greater socioeconomic disadvantage. They had higher all-cause 30-day readmissions (21% vs. 14%; p = 0.048), more total hospitalizations (median 2 vs. 1 stay; p < 0.0001), and shorter LOS (median 4 vs. 5 days; p = 0.04). No differences were observed in 7-day post-hospitalization. Conclusions: Substance use is common among CHF patients at a safety-net hospital and was associated with higher 30-day readmissions as well as shorter hospital stays, which may reflect premature discharge rather than improved recovery. Future studies should assess whether addressing substance use alongside socioeconomic disparities can reduce readmissions in this population.