Hazardous alcohol use among patients in cardiology care: prevalence and current practice in Sweden
Authors: Welfordsson P , Danielsson A K , Bjorck C , Grzymala-Lubanski B , Hambraeus K , Lidin M , Haugen Lofman I , Braunschweig F , Wallhed Finn S 
Published: June 2024

Abstract

Background
Alcohol use is increasingly recognized as a modifiable cardiovascular risk factor, yet the prevalence of hazardous alcohol use – a pattern of drinking that increases the risk of harm – among cardiology patients in Sweden is not known. Moreover, while European guidelines recommend that clinicians ask about alcohol use in every medical assessment, it is unclear whether this happens in practice. Up-to-date knowledge is needed to ensure the implementation of best-practice guidelines.

Purpose
To investigate the prevalence of hazardous alcohol use among patients in cardiology care in Sweden, and the extent to which patients are screened and receive brief interventions for alcohol use.

Methods
We conducted a cross-sectional study of cardiology patients at three hospital sites in Sweden, between October 2022 and August 2023. Assessors approached patients at the study sites to assess eligibility. Inclusion criteria: age ≥18 years; fluent in Swedish or English; consenting. Exclusion criteria: physical, cognitive or mental health problems preventing survey completion. We assessed alcohol use using the AUDIT questionnaire and defined hazardous alcohol use as ≥6 for women or ≥8 for men. Covariates included gender, age and education. We calculated the prevalence of hazardous alcohol use with 95% confidence intervals, and examined for differences and associations with covariates using chi-squared tests and logistic regression models, respectively. Study approval was granted by the Swedish Ethical Review Authority (Dnr: 2022-02059-01).

Results
In total, 1107 patients were included (mean age=69.4 years, range 18–102; 66% male). Primary diagnoses included arrhythmia (28.1%), myocardial infarction (16.9%) and heart failure (16.4%). About 26% of participants reported being educated to university level, 43% to secondary school level and 31% to primary level or lower. Overall prevalence of hazardous alcohol use was 7.8% (95%CI=6.2%–9.3%). We found differences in the prevalence of hazardous alcohol use according to gender (p=.004), age group (p&lt;.001) and education (p=.010). Univariate odds ratios for hazardous alcohol use were 2.20 (95%CI=1.27–3.80) for men, relative to women. When compared to participants aged ≥80 years, odd ratios for hazardous alcohol use were 5.97 (95%CI=2.05–17.36) among participants aged 18–39, 5.09 (95%CI=2.33–11.14) among those aged 40–64, and 2.52 (95%CI=1.15–5.53) among those aged 65–79. About 54% of respondents reported being screened for alcohol use, of whom around 7% reported receiving brief interventions for alcohol use by clinicians.

Conclusions
We found that the prevalence of hazardous alcohol use is approximately 80 per 1,000 patients in cardiology care, yet only around half of patients are currently screened for alcohol use in clinical practice and less than 10% receive brief interventions. Findings indicate a gap in the implementation of current clinical guidelines.