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

Abstract

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.

A review of methamphetamine use and stroke in the young

“…Meth cessation is a cornerstone of optimal patient care. Existing studies provide moderate-strength evidence that meth cessation is associated with reversal of cardiac dysfunction, left ventricular remodeling, and improvement in NYHA functional class ( 100 ). Reduced exposure to the sympathomimetic effects of meth likely results in better blood pressure control.…”

Heartbeat: prevention of atrial fibrillation progression

“…Heart failure associated with methamphetamine use (MethHF) is increasingly prevalent and associated with significant morbidity. In a systemic review of 21 studies addressing MethHF, Manja and colleagues5 found that recovery of left ventricular function after abstinence can be predicted by echocardiography and the extent of fibrosis. Guideline directed medical therapy and female sex are associated with better outcomes (figure 3).…”

“…Furthermore, the dose needed to harm is unknown. Is a single use enough to trigger a cascade leading to heart failure or must an individual use daily for years?’ He concludes that ‘The work of Manja et al 5 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.’…”

Too much heterogeneity: envisioning a new approach to methamphetamine associated heart failure

“…In this issue of Heart , Manja et al report on an important and necessary systematic review of the current published literature, seeking to address some of these issues. Their review included 21 studies: 14 retrospective cohort studies, three case-control studies, two studies with a prospective cohort and two administrative data studies 8. They found that MethHF was associated with increased severity of heart failure and more readmissions.…”

“…Understanding this heterogeneity is critical because, as Manja et al have shown, it is very difficult to study something without a clear consensus on a definition 8. As highlighted in table 4, there is so much more to classifying a patient’s relationship with methamphetamine than simply a positive urine drug screening (UDS).…”