Methamphetamine‐Associated Heart Failure Hospitalizations Across the United States: Geographic and Social Disparities

Abstract

Background Although methamphetamine abuse is associated with the development of heart failure (HF), nationwide data on methamphetamine‐associated HF (MethHF) hospitalizations are limited. This study evaluates nationwide HF hospitalizations associated with substance abuse to better understand MethHF prevalence trends and the clinical characteristics of those patients. Methods and Results This cross‐sectional period‐prevalence study used hospital discharge data from the National Inpatient Sample to identify adult primary HF hospitalizations with a secondary diagnosis of abuse of methamphetamines, cocaine, or alcohol in the United States from 2002 to 2014. All 2014 MethHF admissions were separated by regional census division to evaluate geographical distribution. Demographics, payer information, and clinical characteristics of MethHF hospitalizations were compared with all other HF hospitalizations. Total nationwide MethHF hospitalizations increased from 547 in 2002 to 6625 in 2014 with a predominance on the West Coast. Methamphetamine abuse was slightly more common among primary HF hospitalizations compared with all‐cause hospitalizations (7.4 versus 6.4 per 1000; Cohen h= 0.012; P< 0.001). Among HF hospitalizations, patients with MethHF were younger (mean age, 48.9 versus 72.4 years; Cohen d= 1.93; P< 0.001), more likely to be on Medicaid (59.4% versus 8.8%; Cohen h= 1.16; P< 0.001) or uninsured (12.0% versus 2.6%; Cohen h= 0.36; P< 0.001), and more likely to present to urban hospitals (43.8% versus 28.3%; Cohen h= 0.32 ; P< 0.001) than patients with non‐methamphetamine associated HF. Patients with MethHF had higher rates of psychiatric comorbidities and were more likely to leave the hospital against medical advice. Conclusions MethHF hospitalizations have significantly increased in the United States, particularly on the West Coast. Coordinated public health policies and systems of care are needed to address this rising epidemic.

Case Report Highlighting Cardiovascular Effects of Concomitant Use of Methamphetamine and Marijuana

“…A 9.5% association of adverse effects due to cardiovascular disorders was reported by a multicenter study published in 2011 in cannabis-related hospital admissions [6]. The U.S. National Vital Statistics for 1990-2014 data demonstrated that mortality rates in states where marijuana is legal showed a 2.3% and 1.3% increase in cardiac mortality among men and women, respectively, compared to states where marijuana is not legal [6]. The association between the development of heart failure or exacerbation and marijuana use has not been fully demonstrated [6].…”

“…There are mixed findings in the literature when evaluating the cardiovascular effects of cannabis use. A 9.5% association of adverse effects due to cardiovascular disorders was reported by a multicenter study published in 2011 in cannabis-related hospital admissions [6]. The U.S. National Vital Statistics for 1990-2014 data demonstrated that mortality rates in states where marijuana is legal showed a 2.3% and 1.3% increase in cardiac mortality among men and women, respectively, compared to states where marijuana is not legal [6].…”

“…The U.S. National Vital Statistics for 1990-2014 data demonstrated that mortality rates in states where marijuana is legal showed a 2.3% and 1.3% increase in cardiac mortality among men and women, respectively, compared to states where marijuana is not legal [6]. The association between the development of heart failure or exacerbation and marijuana use has not been fully demonstrated [6]. However, marijuana use was identified as an independent predictor of heart failure with an odds ratio of 1.1 (95% confidence interval, 1.03-1.18, p-value < 0.01) in a retrospective database review of patients diagnosed with heart failure at discharge [6].…”

“…The association between the development of heart failure or exacerbation and marijuana use has not been fully demonstrated [6]. However, marijuana use was identified as an independent predictor of heart failure with an odds ratio of 1.1 (95% confidence interval, 1.03-1.18, p-value < 0.01) in a retrospective database review of patients diagnosed with heart failure at discharge [6].…”

“It’s called overamping”: experiences of overdose among people who use methamphetamine

“…For example, from 2010 to 2017 in Washington state in the Western USA, the age-adjusted rate for methamphetamine-involved hospitalizations increased from 6.3 to 8.5/100,000 [ 21 ]. Nationally, hospital admissions for heart failure involving methamphetamine increased from 547 in 2002 to 6625 in 2014 [ 22 ]. Among people seeking substance use disorder treatment for heroin, the proportion of patients reporting methamphetamine use increased nearly 500% between 2008 and 2017 [ 7 ].…”