Methamphetamine-associated Heart Failure: Clinical phenotypes and Outcomes in a Safety Net Population

Background Methamphetamine use has increased dramatically over the past decade and is associated with the development of heart failure (HF). However, clinical characteristics and outcomes have not been well described. This study aimed to compare clinical characteristics and outcomes among individuals with HF who do and do not use methamphetamines in a safety-net hospital. Method This retrospective matched cohort study included all individuals with HF with history of methamphetamine use and age, gender-, and year-matched controls without history of methamphetamine use within a municipal health system from 2001-2019. 1,783 individuals with methamphetamine use and HF were identified; 12 were excluded due to inability to identify matched methamphetamine-negative controls. Therefore, 1,771 individuals with methamphetamine use and heart failure and 3,542 age, sex, and year-of-HF-diagnosis matched controls with heart failure without methamphetamine use were included. The primary outcome was all-cause mortality. Secondary outcomes included time to HF hospitalization, and 30-day, 90-day, and 1 year HF and all-cause readmissions. Results Median age of the cohort was 52.1 years and 22.6% were female. There was no significant difference in mortality between the two 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) 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 ever hospitalized for HF, individuals with methamphetamine use had increased odds of HF and all-cause readmission at 30 days, 90 days, and 1 year. Conclusion Despite having higher risk of both all cause and HF readmissions, individuals with methamphetamine-associated heart failure did not have higher risk of mortality. Measures to address frequent healthcare utilization among people with methamphetamine use and HF are needed.