Echocardiographic Parameters and Outcomes in Methamphetamine-Associated Heart Failure: A Propensity Score-Weighted Analysis

Abstract

Background: Methamphetamines are a common cause of systolic heart failure (HF). There are limited data on the prognosis associated with hospitalizations for decompensated HF in the setting of methamphetamine use. We aimed to evaluate patient characteristics and outcomes among patients admitted with decompensated HF who had positive drug screens for amphetamines as well as to determine whether any parameters from transthoracic echocardiogram (TTE) can predict outcomes in this population. Methods:This was a retrospective cohort study of consecutive adult patients admitted to the Loma Linda Medical Center who had an active hospital problem of acute on chronic systolic (or systolic and diastolic) HF from 2013 to 2018. Electronic medical records were mined for relevant patient data. Methamphetamine-associated heart failure (MethHF) group was defined as those with an admission urine drug screen (UDS) that was positive for methamphetamines, whereas non-MethHF was defined by patients with negative methamphetamine on UDS or UDS was not done on physician's discretion. The primary outcomes of the study were 30-day composite outcome (defined as combined all-cause readmission and all-cause mortality), 365-day allcause mortality, and length of stay (LOS). Propensity score weighting for these outcomes was performed using demographics, laboratory and clinical variables, and left ventricular ejection fraction (LVEF) as covariates. TTE parameters from presentation were also evaluated to determine if any had prognostic implications.Results: A total of 1,655 patients were included (101 patients with positive urine methamphetamine and 1,554 patients without). Patients with MethHF were younger, more likely to be male, had fewer comorbidities, had lower LVEF, and were more likely to have right ven-tricular systolic dysfunction. In propensity-weighted analyses, there were no significant differences in LOS, 30-day composite outcome, or 365-day mortality between the MethHF and non-MethHF group in (P > 0.05 for all). Presence of at least moderate tricuspid valve regurgitation (TR) was the only TTE predictor of 30-day composite outcome (odds ratio (OR) = 4.67, 95% confidence interval (CI): 1.5 -14.50, P < 0.01) and 365-day mortality (OR = 4.67, 95% CI: 1.5 -14.50, P < 0.01) in the MethHF group. Conclusion:Patients with MethHF admitted for decompensated HF had similar outcomes compared to non-MethHF after adjusting for baseline characteristics. TR is the only TTE value to predict outcomes in this population.

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

“…Results of the literature search are depicted in the PRISMA diagram (figure 3)18 and study details in the online supplemental table. This review includes three case-control studies,19–21 14 retrospective cohort studies,5 7 22–33 two with a prospective cohort component34 35 and two studies of administrative databases 9 36. Patients were recruited in various studies between 1997 and 2020.…”

“…Patients were recruited in various studies between 1997 and 2020. Fourteen studies were based in California,5 9 19–21 24 25 28–33 35 two each from Hawaii7 22 and New Zealand,23 27 one each from Australia26 and Germany,34 and based on the US National Inpatient Sample (NIS) 36. Some patients were included twice (multiple studies from centres in California21 28–31 33 and New Zealand23 27).…”

“…Inclusion criteria were a combination of International classification of Disease (ICD) codes,37 laboratory values (urine drug screen (UDS) for methamphetamine, B-type natriuretic peptide (BNP) levels) and patient history. Number of patients included ranged from 2026 to 165532 in case-control and cohort studies and 42659/662536 in administrative database studies. Mean age of patients with MethHF in included studies ranged from 3526 to 60.7 years5; the majority were male (57%19 to 99%5).…”

“…Domains of variability in studies included the definition of MethHF (decision to include all patients with HF and MU history25 vs only those without another potential aetiology for HF,24 vs only those who had a UDS positive for methamphtamine32), left ventricular ejection fraction (LVEF) cut-off to differentiate reduced and preserved LVEF (40%,24 34 45%25 and 50%28), population (variation in severity of HF in included cohorts, age of the cohort, associated comorbidities), definition of the exposure (history, UDS, ICD codes, a combination), comparator, outcome assessments, duration of follow-up and study design elements. For example, if more than one admission or test result was available, some included the initial event,24 32 others the most recent event22 and yet others the event with the most extreme result 28. Most studies were at moderate to high risk of bias due to poor matching,22 issues related to selection bias,20 32 and presence of confounding 25.…”

“…For example, if more than one admission or test result was available, some included the initial event,24 32 others the most recent event22 and yet others the event with the most extreme result 28. Most studies were at moderate to high risk of bias due to poor matching,22 issues related to selection bias,20 32 and presence of confounding 25. This resulted in very low confidence for most reported estimates.…”