A systematic review published in Heart found that there is an increasing burden on the health care system from methamphetamine-associated heart failure (MethHF).
Investigators from the Veteran’s Affairs Center for Innovation to Implementation and Stanford University searched publication databases through June 2022 for observational studies about MethHF.
This review included 14 retrospective cohort studies, 3 case-control studies, 2 prospective cohort studies, and 2 administrative database studies published between 1997 and 2020. The studies were conducted primarily in the United States and in New Zealand (n=2), Australia (n=1), and Germany (n=1).
The studies reported between 20 and 1655 cases of MethHF. The average age of patients with MethHF ranged between 35 and 60.7 years and most were men (57%-99%). Patients reported smoking, injecting, snorting, and ingesting methamphetamine and using a monthly total dose of 0.35-24.5 g. The mean duration of use prior to MethHF diagnosis was 5 (range, 0-43) years.
The annual inflation-adjusted cost of MethHF hospitalization in California increased by 840% between 2008 to 2018 compared with 82% for all heart failure (HF) etiologies.
In general, 18% of patients developed MethHF within 1 year of methamphetamine use and was described even after a single methamphetamine use. Severity of fibrosis was correlated with duration of use.
Patients with MethHF had high rates of tobacco (53%-94%), alcohol (18%-59%), and cocaine (0.6%-20%) use as well as elevated rates of posttraumatic stress disorder (16.8% vs 4.4%; P =.006), depression (28.7% vs 11.0%; P =.002), and homelessness (47% vs 7%; P =.001) compared with non-MethHF patients, respectively.
Methamphetamine use was a strong predictor for HF hospitalization (incidence rate ratio [IRR], 1.96; 95% CI, 1.85-2.07) and nonadherence to treatment, in which 63% of patients did not show up to follow-up appointments, and prescription refills were filled an average of 5±3.2 months late. Continued methamphetamine use increased risk for left ventricular diastolic diameter increase (hazard ratio [HR], 5.1; 95% CI, 1.4-18) and HF readmission (HR, 1.58; 95% CI, 1.38-1.82).
Methamphetamine use was not an independent predictor for mortality after adjusting for demographics (adjusted HR [aHR], 0.85; 95% CI, 0.71-1.03; P =.09).
Discontinuation of methamphetamine use was associated with left ventricular remodeling, improved functional status, and New York Heart Association functional class improvement. The median time to reversal was 16 (interquartile range [IQR], 8-30) months.
The major limitation of this review was that study heterogeneity made meta-analysis infeasible.
Study authors concluded, “Rigorous prospective studies using uniform definitions including the extent of methamphetamine use disorder are necessary to learn the extent of the cardiovascular impact of methamphetamine use, including MethHF. The increasing prevalence of MethHF across racial/ethnic and sociodemographic groups in the setting of rising methamphetamine use worldwide calls for increased awareness and availability of treatment for methamphetamine addiction. A multidisciplinary approach that addresses social, medical, and behavioral factors associated with MethHF must be evaluated.”
Manja V, Nrusimha A, Gao Y, et al. Methamphetamine-associated heart failure: a systematic review of observational studies. Heart. 2022;heartjnl-2022-321610. doi:10.1136/heartjnl-2022-321610