US Sees a Surge in Cardiomyopathy-Linked Hospital Stays Among Meth Users

The number of cardiomyopathy-associated hospitalizations among methamphetamine users is skyrocketing in the United States, according to a new analysis of data that span from 2008 to 2020.

Mohammad Alfrad Nobel Bhuiyan, PhD (Louisiana State University Health Sciences Center at Shreveport), the study’s senior author, pointed out that meth “has become a very popular street drug” and is particularly dangerous to its users. Many individuals on meth seek medical help only once their health worsens, he noted to TCTMD. “They only go to the hospital when they are already very sick, they’ve overdosed, or are about to die.”

Methamphetamine has been linked to a wide range of cardiovascular diseases, from cardiomyopathy to pulmonary hypertension, coronary artery disease, and arrhythmias.

The current study is unique in that it homes in on patients who were hospitalized for cardiomyopathy, directly comparing those who used meth with those who did not use the drug. Their data suggest that while meth-associated hospital stays have been on the rise for some time, the increase accelerated in 2015, Bhuiyan said.

Veena Manja, MBBS, PhD (VA Northern California Health Care System, Mather, CA), first author of a 2022 review paper on meth-related HF, told TCTMD in an email that the new results hold no surprises and align with prior reports from California and the United States as a whole.

“The temporal and geographic trends point to increasing prevalence in all regions,” she confirmed.

The initial hospital stays of course impact the healthcare system, but Manja drew attention to the fact that there are often downstream effects, with many methamphetamine users returning for visits to the emergency department and readmission for heart failure.

“Cardiologists need to be aware of the increasing meth use across the country and the association between meth use and heart failure—especially those practicing in areas with a recent increase in meth use,” she advised.

The paper, led by Zaki Al-Yafeai, MD, PhD, and Shafaqat Ali, MD (Louisiana State University Health Sciences Center at Shreveport), was published online recently in JACC: Advances.

Using the National Inpatient Sample database, the researchers identified 12,845,919 cardiomyopathy-associated hospital admissions and 1,268,584 methamphetamine-associated hospital admissions between 2008 and 2020.

Meth users accounted for 222,727 of those hospitalized for cardiomyopathy. Most (59%) were men, 62.9% were white, and 56% were between the ages of 41 and 64. Compared with people hospitalized for cardiomyopathy who did not use meth, the methamphetamine users tended to be younger and more likely to be covered by Medicaid insurance. They also were less apt to be Black, while Hispanic, non-Hispanic Asian or Pacific Islander, and non-Hispanic Native American groups made up a larger percentages of the hospitalized meth versus non-meth users.

Cardiomyopathy-associated hospital admissions among methamphetamine users rose by 231% overall during the 13-year study period, and increased both for men (345%) and, to a lesser degree, for women (122%). These hospitalizations also increased across racial/ethnic groups: by 271% for non-Hispanic white, 254% for non-Hispanic Black, 565% for Hispanic, and 645% for non-Hispanic Asian populations. By region, significant increases were seen in the West (530%) and South (200%; P for trend < 0.001 for all). The sharpest upward trends were seen among men, Hispanic individuals, and people aged 26-40 and 41-64 years, as well as in the West.

All-cause mortality in meth users with cardiomyopathy-associated hospitalizations rose by 195% over the same time frame.

But How to ‘Stem the Tide’?

Shannon L. Walker, MD, Nicky J. Mehtani, MD, and Nisha I. Parikh, MD, MPH (all from University of California-San Francisco), in an editorial, point out that research on meth use offers a consistent message. “This work and others highlight that this is a heterogenous problem affecting various genders, populations, and locations differently. Consequently, strategies for prevention and treatment need to be tailored; attention and resources should be directed toward communities with increased need,” they stress.

Walker and colleagues highlight American Indian and Alaskan Native populations, based on this report’s findings as well as earlier data suggesting methamphetamine use is particularly deadly in these groups.

“We must join with these communities and healthcare providers to understand ways in which systemic racism, socioeconomic factors, biology, and behaviors contribute to this disproportionate increase in mortality and relative heart failure in the setting of methamphetamine use,” they write. “We must urgently direct more resources to empower diverse, multidisciplinary teams (inclusive of tribal leadership) in developing and implementing strategies of prevention and treatment within Native communities suffering an increased burden of methamphetamine use and its sequelae.

Manja, looking ahead, also emphasized the need to focus on solutions from a public health perspective. “Efforts to stem the tide of increasing methamphetamine use in society are urgently needed,” she concluded. “Epidemiological data on the frequency of cardiac involvement among meth users, the predisposing factors, trajectory of disease, and impact of sociodemographic factors on disease course are necessary.”

It’s also important to keep digging into pharmacological treatment options for addiction, Manja added.

Bhuiyan said that drug rehab facilities have an important role to play by not only treating the methamphetamine addiction but also being alert to patients’ potential cardiovascular conditions, “just to make sure that their heart is not damaged.” Similarly, emergency physicians addressing an overdose should take time to check for comorbid CVD, he suggested.