Methamphetamine-associated heart failure: Clinical characteristics and outcomes in a safety net population

Background: Methamphetamine use is increasing and is associated with development of heart failure (HF). However, clinical characteristics and outcomes have not been well-described.

Objective: To compare outcomes among individuals with HF with and without methamphetamine use in a safety-net setting.

Methods: This retrospective matched cohort study included individuals with HF with history of methamphetamine use and age, gender-, and year-matched controls without history of methamphetamine use in a municipal health system from 2001 to 2019. One thousand seven hundred seventy-one individuals with methamphetamine use and HF and 3,542 age, sex, and year-of-HF-diagnosis matched controls with HF without methamphetamine use were included. The primary outcome was all-cause mortality. Secondary outcomes included time to HF hospitalization, 30-day, 90-day, and one-year HF, and all-cause readmissions.

Results: The median age of the cohort was 52.1 years and 22.6 % were female. Black/African American was the most common racial identity (methamphetamine: 49.1 %; no methamphetamine: 33 %). There was no significant difference in mortality between groups (40% vs 36.6 %,HR 1.00,95 % CI 0.91,1.10,p = 1.00). A subset had an index HF hospitalization (n = 1,404, 26.4 %) during the study period, including 637 (35.9 %) with history of methamphetamine use and 767 (21.7 %) without history of methamphetamine use (relative risk 1.66,95 % CI 1.52-1.81,p < 0.0001). Among those who were ever hospitalized for HF, individuals with methamphetamine use had increased risk of HF and all-cause readmission at 30 days (RR 1.92,95 % CI 1.36-2.70,p < 0.001), 90 days (RR 1.69,95 % CI 1.35-2.12,p < 0.001), and one year (RR 1.61,95 % CI 1.36-1.91,p < 0.001).

Conclusion: Despite having higher all-cause and HF readmission risk, individuals with methamphetamine-associated HF did not have higher mortality risk.