Hospital Stays for Meth-Related HF Skyrocket, as Do Costs

Hospitalizations for methamphetamine-related heart failure (HF) spiked by nearly sixfold between 2008 and 2018, data from California confirm, outpacing other forms of heart failure in both prevalence and costs.

“Methamphetamine, the archetypal amphetamine-type stimulant, is one of the most commonly used illicit substances in the United States,” Susan X. Zhao, MD (Santa Clara Valley Medical Center, San Jose, CA), and colleagues point out in their paper, published today in Circulation: Cardiovascular Quality and Outcomes. But cardiomyopathy is far from the only cardiovascular consequence of meth use, they note. Others include malignant hypertension, tachyarrhythmias, and myocardial ischemia.

Although there have been smaller studies and case series targeted at methamphetamine HF, this one takes an epidemiological perspective by means of a large data set, Zhao told TCTMD. “This is not a brand-new discovery. This [disease] is known. But what we didn’t know before this was the scale of the problem . . . as well as the financial impact of the disease. Maybe we’re only touching the tip of the iceberg.”

Their results should alert public health specialists, clinicians, and policy makers that “there is a big problem raging right under your nose,” Zhao said.

Hospital Costs Approached $400 Million in 2018

Zhao and colleagues used data from California’s Office of Statewide Health Planning and Development to identify 1,033,076 HF hospitalizations between 2008 and 2018, of which 4.12% were for patients who had meth-related secondary diagnoses.

Patients admitted for HF who used methamphetamines tended to be younger (mean age 49.6 vs 72.2), were more likely to be male (79.1% vs 52.4%), and had fewer comorbidities, such as atrial fibrillation/flutter, CAD, diabetes, hyperlipidemia, cerebrovascular disease/TIA, and peripheral vascular disease. The meth group, however, did have a slightly but significantly higher prevalence of hypertension.

Adjusted for age, meth-related HF hospitalizations rose by 585%, from 4.1 per 100,000 adults in 2008 to 28.1 per 100,000 adults in 2018. Other hospitalizations for HF, meanwhile, decreased by 6.0% over the study period, from 342.3 to 321.6 per 100,000. To help rule out the potential effects of an overall increase in coding for methamphetamine-related diagnoses, the researchers also compared meth users hospitalized for HF against a control group of meth users hospitalized for urinary tract infections, finding that the former increased nearly twice as fast as the latter between 2008 and 2018.

It’s never too late to tell them ‘You may be given a second chance.’ Susan X. Zhao

Black men showed the steepest rise in meth-related HF hospitalization—up by 12.48-fold over 11 years—whereas white men saw a 6.35-fold increase. There were no such changes for most women, though Black women saw an increase exceeding that for Hispanic men.

Patients with meth-related HF tended to have longer hospital stays, undergo more procedures, and see higher costs per stay (mean $123,374 vs $87,896). Adjusted for inflation, hospital costs due to meth-related HF increased from $41.5 million in 2008 to $390.2 million in 2018, an 840% change. For other types of HF hospitalization, costs rose by just 82% (from $3.5 billion to $6.4 billion).

“This emerging HF phenotype, which engenders considerable financial and societal costs, calls for an urgent and concerted public health response to contain its spread,” the investigators urge.

Beyond the unique demographic features of meth-related HF patients, they also tend to present differently, Zhao noted. “They usually present at much later stage. They’re young, they’re not used to seeing a doctor. . . . It’s very hard to dig them out of the hole, so to speak. The symptoms are similar, but usually much more severe.” They also may show end-organ damage, such as kidney or liver dysfunction.

While treatment for these individuals is largely similar to what it would be for equally severe HF patients who don’t use meth, she said, there’s one key thing to remember—data from their center show that up to one-third of meth users can see their LV function return “if they stop methamphetamine, if they’re compliant with heart failure medications, and if they present a [little bit] earlier in their course.”

For patients showing the signs of meth-related HF, stressed Zhao, “it’s never too late to tell them, ‘You may be given a second chance.’”

‘Years of Healthy Living Lost’

Pavan Reddy, MD (Mount Sinai Morningside, New York, NY), and Uri Elkayam , MD (University of Southern California, Los Angeles), in an accompanying editorial, note that the true costs of the disability posed by meth-related HF are “difficult to estimate as it is a loss of opportunity rather than an up-front cost, but can be expected be substantial given the young age at which patients develop [the condition].”

One way of thinking about this loss, as quantified by the World Drug Report, is disability-adjusted live years. The concept captures “years of healthy living lost due to drug-related disability and years lost to premature death,” they explain. “It is a useful measure to help grasp what is truly lost by both the individual and community and is particularly apt in the case of methamphetamine addiction given its tendency to debilitate over longer periods of time, by means of psychiatric and cardiac sequela, rather than by killing instantly.”

This is all the more reason to provide substance-use recovery services early during the course of the disease, the editorialists stress. “Clinicians should understand that management of meth HF cannot end with volume optimization and must include efforts to avoid repeat hospitalization. The current study showed high rates of readmission; we can speculate that this is related to patients’ ongoing use of methamphetamines after discharge, which not only exacerbates hemodynamics but also portends poor medication compliance, ultimately circling back to readmission.”

Before HF develops, physicians can also play a role in prevention, Zhao suggested. “Grab every chance to essentially educate the public about cessation. It’s all about raising awareness.” This can happen at high school or community health fairs, for example. “For people who maybe have the smallest inclination to start using it casually and think, ‘Oh, this is going to pick me up and make me feel a little better,’ say: ‘Don’t do that. It’s not really worth it. You don’t want to end up 10 years later in the cardiac ICU, gasping for air with multiorgan failure and [congestive heart failure].’”

Zhao stressed that, for those treating patients who use meth, empathy is key: “Over the past 10 years, life has been hard for many people: job security, the economy, most recently the pandemic. People have been finding ways to cope with the harshness of life. And this may be one of the coping mechanisms. Don’t give up on them. Keep reaching out to them.”