Characteristics and Outcomes of Methamphetamine Abuse Among Veterans With Heart Failure

Nishimura, Marin; Ma, Janet; Fox, Sutton; Toomu, Avinash; Mojaver, Sean; Juang, Derek; Maisel, Alan S.; Thomas, Isac C.

doi:10.1016/j.amjcard.2019.05.068

Cited by 18 publications

(21 citation statements)

References 17 publications

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“…Patients with methamphetamine-associated cardiomyopathy, however, were ≈10-years younger. 95 Although MDMA has been reported to cause atrial fibrillation in isolated case reports, systematic reporting of any association is lacking. 96…”

Section: Substituted Amphetamines and Atrial Arrhythmiasmentioning

confidence: 99%

Stimulant Drugs of Abuse and Cardiac Arrhythmias

Dominic

Ahmad

Awwab

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Nonmedical use of prescription and nonprescription drugs is a worldwide epidemic, rapidly growing in magnitude with deaths because of overdose and chronic use. A vast majority of these drugs are stimulants that have various effects on the cardiovascular system including the cardiac rhythm. Drugs, like cocaine and methamphetamine, have measured effects on the conduction system and through several direct and indirect pathways, utilizing multiple second messenger systems, change the structural and electrical substrate of the heart, thereby promoting cardiac dysrhythmias. Substituted amphetamines and cocaine affect the expression and activation kinetics of multiple ion channels and calcium signaling proteins resulting in EKG changes, and atrial and ventricular brady and tachyarrhythmias. Preexisting conditions cause substrate changes in the heart, which decrease the threshold for such drug-induced cardiac arrhythmias. The treatment of cardiac arrhythmias in patients who take drugs of abuse may be specialized and will require an understanding of the unique underlying mechanisms and necessitates a multidisciplinary approach. The use of primary or secondary prevention defibrillators in drug abusers with chronic systolic heart failure is both sensitive and controversial. This review provides a broad overview of cardiac arrhythmias associated with stimulant substance abuse and their management.

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Section: Substituted Amphetamines and Atrial Arrhythmiasmentioning

confidence: 99%

Stimulant Drugs of Abuse and Cardiac Arrhythmias

Dominic

Ahmad

Awwab

et al. 2022

Circ: Arrhythmia and Electrophysiology

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“…Simultaneous cocaine and alcohol use is also common and contributes to worse cardiovascular outcomes [48,49]. Patients using stimulants who develop chronic cardiovascular conditions such as heart failure, despite being younger, face more severe in-hospital complications with higher rates of readmission compared to patients with non-stimulant-related heart failure [50,51]. These findings suggest a need for targeted cardiopulmonary interventions for people who present to the ED with stimulant-related diagnoses.…”

Section: Weighted % (95% Ci)mentioning

confidence: 99%

Emergency department visits and trends related to cocaine, psychostimulants, and opioids in the United States, 2008–2018

et al. 2022

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Background Drug-related emergency department (ED) visits are escalating, especially for stimulant use (i.e., cocaine and psychostimulants such as methamphetamine). We sought to characterize rates, presentation, and management of ED visits related to cocaine and psychostimulant use, compared to opioid use, in the United States (US). Methods We used 2008–2018 National Hospital Ambulatory Medical Care Survey data to identify a nationally representative sample of ED visits related to cocaine and psychostimulant use, with opioids as the comparator. To make visits mutually exclusive for analysis, we excluded visits related to 2 or more of the three possible drug categories. We estimated annual rate trends using unadjusted Poisson regression; described demographics, presenting concerns, and management; and determined associations between drug-type and presenting concerns (categorized as psychiatric, neurologic, cardiopulmonary, and drug toxicity/withdrawal) using logistic regression, adjusting for age, sex, race/ethnicity, and homelessness. Results Cocaine-related ED visits did not significantly increase, while psychostimulant-related ED visits increased from 2008 to 2018 (2.2 visits per 10,000 population to 12.9 visits per 10,000 population; p < 0.001). Cocaine-related ED visits had higher usage of cardiac testing, while psychostimulant-related ED visits had higher usage of chemical restraints than opioid-related ED visits. Cocaine- and psychostimulant-related ED visits had greater odds of presenting with cardiopulmonary concerns (cocaine adjusted odds ratio [aOR] 2.95, 95% CI 1.70–5.13; psychostimulant aOR 2.46, 95% CI 1.42–4.26), while psychostimulant-related visits had greater odds of presenting with psychiatric concerns (aOR 2.69, 95% CI 1.83–3.95) and lower odds of presenting with drug toxicity/withdrawal concerns (aOR 0.47, 95%CI 0.30–0.73) compared to opioid-related ED visits. Conclusion Presentations for stimulant-related ED visits differ from opioid-related ED visits: compared to opioids, ED presentations related to cocaine and psychostimulants are less often identified as related to drug toxicity/withdrawal and more often require interventions to address acute cardiopulmonary and psychiatric complications.

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“…1 Common routes of administration, related adverse effects, bioavailability and pharmacokinetics are presented in figure 2. Prevalence of methamphetamine use (MU) is increasing around the world2 3 resulting in significant mortality and morbidity4 5 including cardiovascular effects 1. MU is associated with hypertension, myocardial infarction, stroke, aortic dissection and sudden death 6.…”

Section: Introductionmentioning

confidence: 99%

“…Patient and societal impact of MethHF are increasingly recognised and reported in the literature. Compared with patients with heart failure (HF) without a history of MU (nonMethHF), patients with MethHF are younger with higher polysubstance use and psychiatric disorders 5. In California, MethHF hospitalisations increased from 1.2% of all HF hospitalisations in 2008 to 8% in 2018 9…”

Section: Introductionmentioning

confidence: 99%

Methamphetamine-associated heart failure: a systematic review of observational studies

Manja

Nrusimha

Gao

et al. 2022

Heart

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ObjectiveTo conduct a systematic review of observational studies on methamphetamine-associated heart failure (MethHF) .MethodsSix databases were searched for original publications on the topic. Title/abstract and included full-text publications were reviewed in duplicate. Data extraction and critical appraisal for risk of bias were performed in duplicate.ResultsTwenty-one studies are included in the final analysis. Results could not be combined because of heterogeneity in study design, population, comparator, and outcome assessment. Overall risk of bias is moderate due to the presence of confounders, selection bias and poor matching; overall certainty in the evidence is very low. MethHF is increasing in prevalence, affects diverse racial/ethnic/sociodemographic groups with a male predominance; up to 44% have preserved left-ventricular ejection fraction. MethHF is associated with significant morbidity including worse heart failure symptoms compared with non-methamphetamine related heart failure. Female sex, methamphetamine abstinence and guideline-directed heart failure therapy are associated with improved outcomes. Chamber dimensions on echocardiography and fibrosis on biopsy predict the extent of recovery after abstinence.ConclusionsThe increasing prevalence of MethHF with associated morbidity underscores the urgent need for well designed prospective studies of people who use methamphetamine to accurately assess the epidemiology, clinical features, disease trajectory and outcomes of MethHF. Methamphetamine abstinence is an integral part of MethHF treatment; increased availability of effective non-pharmacological interventions for treatment of methamphetamine addiction is an essential first step. Availability of effective pharmacological treatment for methamphetamine addiction will further support MethHF treatment. Using harm reduction principles in an integrated addiction/HF treatment programme will bolster efforts to stem the increasing tide of MethHF.

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Characteristics and Outcomes of Methamphetamine Abuse Among Veterans With Heart Failure

Cited by 18 publications

References 17 publications

Stimulant Drugs of Abuse and Cardiac Arrhythmias

Stimulant Drugs of Abuse and Cardiac Arrhythmias

Emergency department visits and trends related to cocaine, psychostimulants, and opioids in the United States, 2008–2018

Methamphetamine-associated heart failure: a systematic review of observational studies

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