The connection between using methamphetamines—or “meth” or “crystal”—and non‐ischemic cardiomyopathy and heart failure (HF) has received little attention, even though evidence suggests abuse rates are rising throughout the United States. Because methamphetamines can modulate heart rate, heart contractility, and vasoconstriction, people who use these illicit drugs can experience a wide range of adverse cardiovascular consequences, including tachycardia, hypertension, pulmonary arterial hypertension, and dilated cardiomyopathy. In addition, studies show that some methamphetamine abusers may present with methamphetamine‐associated heart failure (MethHF).
Despite widespread prevalence of methamphetamine use and its potential for cardiovascular harm, the epidemiology and clinical characteristics of people who use these drugs and are admitted for decompensated HF continues to be largely undefined in the US. “Research is urgently needed because hospitalizations for decompensated HF are associated with higher rates of subsequent readmission or mortality,” says Laith Alshawabkeh, MD, MSCI. Furthermore, cardiovascular mortality related to HF has become increasingly more pronounced in younger individuals.
MethHF Hospitalization Rates Rising in Different Regions
For a study published in the Journal of the American Heart Association, Dr. Alshawabkeh and colleagues analyzed hospital discharge data from the National Inpatient Sample to identify adult primary HF hospitalizations with a secondary diagnosis of abusing methamphetamines, cocaine, or alcohol from 2002-2014. The authors then separated all 2014 MethHF admissions by region to evaluate how these admissions were geographically distributed.
Results showed that rates of MethHF hospitalizations increased across the country from 2002-2014. The prevalence of MethHF hospitalizations was much more heavily concentrated in states west of the Mississippi River, particularly along the Pacific coast (Figure). In 2014, MethHF hospitalizations were nearly 500 times more prevalent in the Pacific region compared with the Middle Atlantic region.
Identifying Other Key MethHF Trends
The study also demonstrated that methamphetamine abuse was slightly more common among primary HF hospitalizations when compared with all‐cause hospitalizations. Researchers found that patients with MethHF tended to be younger, were more likely to be on Medicaid or uninsured, and more often presented to urban hospitals than patients with non‐methamphetamine associated HF. Patients with MethHF also had higher rates of psychiatric comorbidities and were more likely to leave the hospital against medical advice. Of note, MethHF was present across all racial groups, but White patients accounted for more than half (55%) of MethHF cases.
The national inpatient data presented in the study show a striking increase in MethHF hospitalizations from 2002-2014, especially when compared with recent HF hospitalization trends seen with other cardiotoxic substances of abuse like cocaine or alcohol, says Dr. Alshawabkeh. “Our study is among the first to demonstrate the worsening MethHF public health crisis across the US.”
As methamphetamine continues to become more affordable, current trends showing a high prevalence of MethHF are unlikely to decline, especially as more potent methamphetamine becomes available in different areas of the country. Studies are needed to further explore exactly why the identified geographical discrepancies exist and to better understand why some methamphetamine abusers develop HF while others do not.
Increasing Vigilance: An Important First Step
Recognizing the severity of the growing MethHF epidemic is critical to addressing this public health problem. Unfortunately, the euphoric and physiologic effects can sometimes mask traditional HF symptoms, which in turn may prolong time to a diagnosis. “The first step is to be vigilant about patients with suspected MethHF,” Dr. Alshawabkeh says. Greater efforts should be made by healthcare providers to diagnose and document methamphetamine abuse in patients in a timely fashion, regardless of whether HF is expected.
The study team noted that efforts to decrease methamphetamine abuse will require coordination with all sectors of healthcare. “If patients are found to be abusing methamphetamine, they need to be guided to cessation resources,” says Dr. Alshawabkeh. Helping patients quit methamphetamine may lead to positive cardiac remodeling and improved clinical outcomes.