Cannabis use associated with lower AF risk in heart failure

Relation of Cannabis Use and Atrial Fibrillation Among Patients Hospitalized for Heart Failure

Literature - Adegbala O, Adejumo AC, Olakanmi O, et al. - Am J Cardiol 2018; published online ahead of print

Introduction and methods

Left ventricular dysfunction is compensated by the activation of the sympathetic nervous system, leading to increased inotropic effect, as well as to an increased risk of atrial fibrillation (AF) [1]. Cannabis is a popular recreational drug worldwide, which might impact the occurrence of AF in patients with heart failure (HF), since cannabis has dose-dependent different effects on the autonomic nervous system [2].

In this retrospective analysis, the association between cannabis use and AF in patients with HF was evaluated, in a 2014 Healthcare Cost and Utilization Project–National Inpatient Sample (NIS) data set [3]. All adult patients (age ≥18 years) with a diagnosis of primary and secondary HF were included, and in patients with a discharge diagnosis of AF cannabis users were identified. Cannabis users were compared 1:1 with propensity matched non-users. Each group included 3,548 patients.

Main results

  • Out of 3,950,392 patients hospitalized for HF in 2014, 17,755 (0.45%) were cannabis users.
  • When compared with nonusers, cannabis users were younger, more likely to be female, and black, more likely to have chronic lung diseases, chronic liver disorders, depression, obesity, psychiatric disorders, alcohol abuse, and tobacco use.
  • Cannabis users were less likely to have AF, hypertension, diabetes mellitus, chronic kidney disease, rheumatologic disorders, and peripheral arterial disease.
  • Cannabis users had a reduced rate of AF (19.08% vs 21.39%; P=0.015) and a 13% reduction in the odds of AF compared with nonusers (AOR: 0.87; 95%CI: 0.77-0.98; P=0.018).


In a retrospective analysis of a healthcare cost and utilization database, cannabis use was associated with a lower AF risk in HF patients, compared with propensity matched controls. The authors suggest that cannabis might have a protective effect on AF, possibly through the endocannabinoid system.


1. Agarwal SK, Norby FL, Whitsel EA, et al. Cardiac autonomic dysfunction and incidence of atrial fibrillation: results from 20 years follow-up. J Am Coll Cardiol 2017;69:291–299.

2. Rodríguez de Fonseca F, Del Arco I, Bermudez-Silva FJ, et al. The endocannabinoid system: physiology and pharmacology. Alcohol Alcohol 2005;40:2–14.

3. Agency for Healthcare Research and Quality (AHRQ). HCaUPH. Overview of the National (Nationwide) Inpatient Sample (NIS). Available at: Accessed on March 22, 2017.

Find this article online at Am J Cardiol

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