Heart Failure From Meth Use: Growing Beast Lurks in the Shadows

In recent years, methamphetamine-associated heart failure (MethHF) ensnared more people across sociodemographic groups without showing signs of relenting, according to the limited data available.

Although reliable estimates are lacking, the prevalence of MethHF is likely increasing in step with rising methamphetamine use worldwide, reported a group led by Veena Manja, MBBS, PhD, a cardiologist and healthcare researcher at the VA Center for Innovation to Implementation in Menlo Park, California.

Such growth in MethHF “calls for increased awareness and availability of treatment for methamphetamine addiction,” the authors concluded from their systematic review, published in Heart.

One California center reported in 2019 that the prevalence of methamphetamine abuse was at 5.2% among its heart failure patients, though Manja and colleagues argued that such observational reports are hindered by inconsistent drug use history-taking and testing in heart failure patients due to low clinician awareness.

“Clinicians from diverse disciplines including cardiology, primary care, psychology, addiction treatment and social services need to synchronise their efforts to support individuals with MethHF overcome the social and structural barriers to recovery,” the authors wrote. “Due to the complex behavioural and social effects of methamphetamine addiction, these patients may need support beyond that traditionally offered in heart failure treatment programs.”

The researchers found that MethHF was associated with particularly severe heart failure, longer inpatient stays, and more readmissions. From 2008 to 2018, annual inflation-adjusted hospitalization charges for MethHF grew by an estimated 840% (from $41.5 million to $390.2 million) compared with 82% (from $3.503 billion to $6.376 billion) for all heart failure.

The “staggering” healthcare costs were highlighted by heart failure specialist Jonathan Davis, MD, MPHS, of Zuckerberg San Francisco General Hospital and University of California San Francisco, in an accompanying editorial.

“Meaningful progress necessitates that healthcare systems financially commit to novel care delivery approaches that support and encourage patient engagement and reduce methamphetamine use. The work of Manja et al highlights that the standard of care academically and clinically must be a broad team across the care spectrum to simultaneously address methamphetamine use, heart failure and social determinants of health,” he wrote.

The systematic review included 21 observational studies. Study participants had been recruited in various studies between 1997 and 2020.

Manja’s team cautioned that the studies could not be pooled in a meta-analysis because of heterogeneity in study design, population, comparator, and outcome assessment.

“The inclusion criteria ranged so widely that the various studies included completely different patient populations and yielded often contradictory results; for example, one study reported longer length of stay and another the opposite,” Davis observed.

Moreover, most studies in the systematic review were small and retrospective, with moderate to high risk of bias due to lack of matching and potential selection bias.

Nevertheless, the authors reported that female sex, methamphetamine abstinence, and guideline-directed heart failure therapy were associated with improved outcomes. Additionally, recovery after abstinence from methamphetamines may be predicted by echocardiographic parameters and fibrosis on biopsy.

Manja and colleagues called for well-designed prospective studies of people who use methamphetamine to accurately assess the epidemiology, clinical features, disease trajectory, and outcomes of MethHF. A multidisciplinary approach that addresses social, medical, and behavioral factors associated with MethHF should be evaluated along with potential treatment options, the researchers added.

“General healthcare’s successful experience with management of the opioid epidemic needs to be translated and expanded to treatment of MUD [methamphetamine use disorder]. Further research is essential to supporting clinicians in providing effective patient-centred treatment to individuals with MethHF and improve outcomes,” the team concluded.