Methamphetamine Use Growing More Common in Veterans With Heart Failure

ANAHEIM, CA—Clinicians may need to come up with a multidisciplinary strategy for treating patients admitted for heart failure who have a history of methamphetamine use, a growing problem, according to new research.

In the VA San Diego Healthcare System, the percentage of veterans with heart failure who had a history of methamphetamine use increased from 1.7% in 2005 to 8.0% in 2015, Marin Nishimura, MD (University of California, San Diego), reported last week at the American Heart Association 2017 Scientific Sessions.

Patients with such a history were younger on average, were more likely to be homeless and unemployed, and had higher rates of psychiatric comorbidities and substance abuse. Effective treatment would include not just managing heart failure, but also helping in these other areas, Nishimura told TCTMD.

“When we’re taking care of patients with methamphetamine-associated heart failure we should also look into addressing other domains as well, including their psychiatric health and substance abuse issues,” she said.

Although methamphetamine-associated heart failure is becoming increasingly important, it remains poorly characterized. To help fill the gap, Nishimura and colleagues examined electronic health records for patients admitted for heart failure between 2005 and 2015. The analysis included 106 with and 96 without a history of methamphetamine use.

Some important differences emerged between the two groups. Methamphetamine users were about a decade younger on average (60.7 vs 71.0 years). They were less likely to have A-fib, prior CABG, cerebrovascular disease, and hyperlipidemia but more likely to report use of alcohol, cocaine, marijuana, and heroin. In addition, patients with a history of methamphetamine use were more likely to have posttraumatic stress disorder and depression.

After discharge, methamphetamine users had a higher mean number of annual emergency room visits (1.9 vs 0.9; P = 0.01) and greater use of addiction services (29.4% vs 2.2%) and psychiatric services (56.5% vs 8.8%; P < 0.001 for both).

The investigators delved deeper into the characteristics of patients with methamphetamine-associated heart failure by dividing them into those with reduced ejection fraction (< 40%) and those with preserved ejection fraction. They dubbed the two groups MethrEF (mean LVEF 24.4%) and MethpEF (mean LVEF 61.9%), respectively.

The MethrEF and MethpEF groups had generally similar clinical characteristics and comorbidities, although patients with reduced ejection fraction had a lower average body weight, a lower rate of chronic obstructive pulmonary disease, and a higher rate of chronic kidney disease.

Those with MethrEF were more likely than those with MethpEF to die from any cause through a mean follow-up of 698.2 days (P = 0.0008). Moreover, after adjustment for potential confounders, these patients had a 12.2-fold greater risk of all-cause mortality when looking at the overall heart failure cohort (P < 0.001).

Nishimura said that at this point there is not a big difference in how patients with methamphetamine-associated heart failure are treated compared with the general heart failure population.

“That’s why this study is important, because we found there are important differences and there are other things that we should be looking into and primarily focusing on in these patients,” Nishimura said. Physicians can administer optimal heart failure medications, she added, “but if you’re not addressing the psychiatric comorbidities and the substance abuse issues, then you’re not really addressing the primary issue here. This study suggests that maybe we should be taking a multidisciplinary approach for their care.”