Initiation of medications for alcohol use disorder at hospital discharge significant improves outcomes

1. This retrospective study found that the use of medications for alcohol use disorder (MAUD) (including naltrexone, acamprosate, and disulfiram) at discharge from hospital significantly reduced 30-day all-cause mortality, 30-day return to hospital for any reason, and improved rates of primary care and mental health follow-up post-discharge.

Evidence Rating Level: 2 (Good)

Alcohol use disorder (AUD) affects 29 million adults in the United States and is a leading cause of preventable mortality. Current Food and Drug Administration (FDA) guidelines recommend both behavioural and pharmacologic interventions for AUD, often referred to as medications for AUD (MAUD). These include naltrexone, acamprosate, and disulfiram, but despite being included in the guidelines, they are grossly underprescribed. These medications make use of differing mechanisms to reduce return to drinking or heavy drinking, and the literature on outcomes associated with MAUD initiation at hospital discharge is scant. Thus, the current retrospective cohort study emulated a randomized clinical trial to investigate the impact of initiating MAUD at hospital discharge on 30-day clinical outcomes among patients hospitalized for alcohol-related reasons. In total, 9834 alcohol-related hospitalizations (median [IQR] age, 54 [46-62] years; 32.6% female) by 6794 unique individuals were included. Only 2.0% of hospitalizations included a MAUD prescription at discharge. However, MAUD initiation was associated with a 42% relative and 18% absolute reduction in 30-day all-cause mortality or a return to hospital compared to those who did not receive MAUD (IRR, 0.58 [95% CI, 0.45 to 0.76]; ARD, −0.18 [95% CI, −0.26 to −0.11]). Secondary outcomes, including a return for any reason (IRR, 0.56 [95% CI, 0.43 to 0.73]; ARD, −0.19 [95% CI, −0.27 to −0.12]) and alcohol-related diagnoses (IRR, 0.49 [95% CI, 0.34 to 0.71]; ARD, −0.15 [95% CI, −0.22 to −0.09) were significantly reduced in the MAUD group. Finally, follow up with primary care or mental health services was also associated with MAUD initiation at discharge (IRR, 1.22 [95% CI, 1.04 to 1.44]; ARD, 0.10 [95% CI, 0.02 to 0.18]). Overall, this cohort study found that discharge MAUD initiation decreased 30-day mortality, 30-day all-cause return to hospital, and was correlated to increased primary or mental health care follow-up in patients struggling with AUD. The inherent limitations of an observational study design may decrease its generalizability, but randomized trials should be conducted to elucidate the findings of the current study. Discharge MAUD may present a feasible method by which to increase primary and mental health follow up and temporize rates of 30-day mortality and a return to hospital in individuals struggling with AUD. 

Click to read the study in JAMA Network Open

Image: PD

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