Assessment of Contributing Risk Factors Leading to Heart Failure in Patients Who Are Methamphetamine Users.

Background: Methamphetamine abuse is a public health problem across the world, and the cardiovascular system experiences a significant effect on the myocardium over time. Methamphetamine is a common cause of heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). The prevalence and risk factors for HFpEF and HFrEF in this patient population remain unclear.

Methods: This retrospective case-control study is based on a chart review of patients from 139 Hospital Corporation of America (HCA) community hospitals across the United States from January 2013 to December 2017. Active methamphetamine users were identified based on International Classification of Diseases (ICD) codes and a positive urine drug screen during hospitalization. The total number of patients was then divided into two groups: heart failure (HF) vs. no HF. Then exclusion criteria were applied to remove any possible characteristics that might confound the data. The number of patients left was then analyzed.

Results: This study identified 9,518 active methamphetamine users, with 403 patients (4.23%) having HF, 41 having unspecified HF, and 51 having HFpEF only, vs. 311 having HFrEF only, compared to 9,115 in the control group without HF. After exclusion criteria were applied, the HF group had 166 patients, and the control group had 398 patients. Heart failure was significantly higher in men, 65.7% men compared to 34.3% women (adjusted odds ratio (OR): 1.894, p = 0.022). The average ages of HF group patients before exclusion criteria, after exclusion criteria, and in the control group were 52.5 years, 46.5 years, and 42.7 years, respectively. The age difference between the HF group (average 46.5 years old) and the control group (average 42.7 years old) was not statistically significant (adjusted OR: 1.007, p = 0.540). However, the average age of the HFpEF population significantly differs from the HFrEF population, 70.2 years old compared to 47.1 years old, respectively (adjusted OR: 1.053, p = 0.001). Female patients appeared to be more likely to have HFpEF (70.6%) compared to HFrEF (18.9%, adjusted OR: 3.738, p < 0.001).

Conclusion: Amongst methamphetamine users who develop HF, men appeared to be affected more compared to women. This difference may stem from the differences in activities between men and women. On the other hand, age appeared to not play a role when viewing the entire HF group as a whole. However, when broken down into reduced and preserved groups, age appeared to play a significant role in the type of HF that methamphetamine users may develop. The HFpEF age in methamphetamine users appeared to follow the trend of the general population age with HFpEF. The HFrEF rate was about six times higher among methamphetamine users, excluding the population with unspecified HF. Higher rates of methamphetamine abuse are prompting further studies and programs to reduce cardiac morbidity and mortality in this group and decrease the burden on health systems.