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Published on: January 22, 2016
Clinical Characteristics and Outcomes of Patients With Heart Failure and Methamphetamine Abuse
Isac C Thomas1, Marin Nishimura1, Janet Ma1
1Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California.
Insights
Methamphetamine-associated heart failure (MethHF) patients are younger, more often male, and have higher readmission rates than general heart failure (HF) patients. MethHF patients also present with more comorbidities, including substance use disorders.
Area of Science:
- Cardiology
- Toxicology
- Psychiatry
Background:
- Methamphetamine abuse is a global epidemic.
- Methamphetamine-associated heart failure (MethHF) is poorly understood.
- This study evaluates MethHF characteristics and outcomes.
Purpose of the Study:
- To characterize patients with MethHF.
- To compare MethHF outcomes to general heart failure (HF).
- To identify predictors of poor outcomes in MethHF.
Main Methods:
- Retrospective review of electronic health records (2005-2016).
- Comparison of 896 MethHF patients with 20,576 HF patients.
- Identification using diagnosis codes, urine toxicology, and natriuretic peptides.
Main Results:
- MethHF patients were younger (50 vs. 67 years), predominantly male (72% vs. 54%), and had more psychiatric/substance use comorbidities.
- MethHF showed a higher 5-year HF readmission rate (64% vs. 45%) but a lower 10-year mortality rate (25% vs. 28%).
- Mood/anxiety disorders and opioid abuse predicted poor outcomes.
Conclusions:
- MethHF patients often have psychiatric and substance abuse comorbidities.
- These patients face significant risks of HF readmission and mortality.
- Comprehensive strategies are needed to address this growing public health issue.
Background:
Despite a global epidemic of methamphetamine abuse, methamphetamine-associated heart failure (MethHF) remains poorly understood. We sought to evaluate characteristics and outcomes for patients with MethHF.
Methods:
We reviewed the electronic health records of the University of California, San Diego, from 2005 to 2016. We compared characteristics and outcomes between 896 patients with MethHF and 20,576 patients with heart failure (HF) identified using diagnosis codes, urine toxicology, and natriuretic peptides.
Results:
Compared with HF, patients with MethHF were younger (50±10 vs 67±16 years), predominantly male (72% vs 54%), and had more psychiatric and substance use comorbidities, including mood/anxiety disorders (29% vs 16%) and opioid use (44% vs 7%). MethHF had a higher 5-year HF readmission rate (64±4% vs 45±1%; hazard ratio [HR] 1.53, P < .001) and a lower 10-year total mortality rate (25±3% vs 28±1%; HR 0.85, P = .09). Predictors of poor outcomes included mood/anxiety disorders (HF readmission HR 1.41, P = .04) and opioid abuse (mortality HR 1.52, P = .04).
Conclusions:
Patients with MethHF are frequently encumbered by psychiatric and substance abuse comorbidities, and carry a substantial risk of HF readmission and mortality. Comprehensive efforts are needed to stem this emerging epidemic.
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