Volume 270, April 2024, Pages 156-160Author links open overlay panel, , , , , , Background

Although methamphetamine use associated heart failure (MU-HF) is increasing, data on its clinical course are limited due to a preponderance of single center studies and significant heterogeneity in the definition of MU-HF in the published literature. Our objective was to evaluate left ventricular ejection fraction (LVEF) distribution, methamphetamine use treatment engagement and postdischarge healthcare utilization among Veterans with heart failure hospitalization in the department of Veterans Affairs (VA) medical centers for MU-HF versus HF not associated with methamphetamine use (other-HF).

Methods

Observational study including a cohort of Veterans with a first heart failure hospitalization during 2007 - 2020 using data in the VA Corporate Data Warehouse. MU-HF was identified based on the presence of an ICD-code for methamphetmaine use or positive toxicology results within 1-year of heart failure hospitalization. LVEF values entered in the medical record were identified using a validated natural language processing algorithm. Healthcare utilization data was obtained using clinic stop-codes and hosptilaization records.

Results

Of 203,005 first-time heart failure hospitlaizations, 4080 were categorized as MU-HF. Median (interquartile range) of LVEF was 30 (20-45) % for MU-HF versus 40 (25-55)% for other-HF (P < .0001). Eighteen percent of MU-HF had LVEF ≥ 50% compared to 28% in other-HF. Discharge against medical advice was higher in MU-HF (8% vs 2%). Among Veterans with MU-HF, post hospital discharge methamphetamine use treatment engagement was low (18% at 30 days post discharge), with higher follow-up in primary care (76% at 30 days). Post discharge emergency department visits (33% versus 22% at 30 days) and rehospitalizations (24% versus 18% at 30 days) were higher in MU-HF compared to other-HF.

Conclusions

While the majority of MU-HF hospitalizations are HFrEF, a sizeable minority have HFpEF. This finding has implications for accurate MU-HF classification, treatment, and prognosis. Patients with MU-HF have low addiction treatment receipt and high postdischarge unplanned healthcare utilization. Increasing substance use disorder treatment in this population must be a priority to improve health outcomes. Care-coordination and linkage interventions are urgently needed to increase post-hospitalization addiction treatment and follow-up in an effort to increase evidence-base care and mitigate unplanned healthcare utilization.

Section snippetsMethods

In this observational study using data from VA Medical Centers across the US in the corporate data warehouse (CDW), we created a cohort of veterans with first HF hospitalizations during 2007 to 2020 with a primary discharge-diagnosis of HF based on ICD-code. HF was classified as MU-HF or other-HF based on MU related ICD-code or a toxicology result positive for methamphetamine entered in the medical record within +/− 1-year of HF hospitalization. We chose a duration of +/− 1 year from the index

Results

Of the 203,005 first HF hospitalizations, 4,080 were classified as MU-HF. The mean (standard deviation) for age of Veterans with MU-HF was 61 (9) compared to 73 (12) years for other-HF (P < .0001); 98% were male and higher proportion of MU-HF were Black (25% vs 21% in Other-HF). Basic demographics are presented in Table 1.

Median (interquartile range) of LVEF was 30 (20-45) % for MU-HF versus 40 (25-55)% for other-HF (P < .0001). The range of LVEF among HF hospitalizations is presented in Figure

Discussion

We report the range of LVEF in patients with MU-HF compared to other-HF in a large integrated US healthcare system. Our results confirm previous single center reports of a higher proportion of MU-HF with HFrEF and within HFrEF a higher proportion with severely depressed LVEF.2 The 10% prevalence of HFmrEF is comparable to a prior report2; the proportion with HFpEF is in between those reported in previous single center studies.2 Patients with MU-HF have a high rate of discharge against medical

Conclusion

While the majority of MU-HF hospitalizations are HFrEF, a sizeable minority have HFpEF. This finding has implications for accurate MU-HF classification, treatment, and prognosis. Impact of LVEF on treatment and prognosis specific to MU-HF needs further study. Patients with MU-HF have low addiction treatment receipt and high postdischarge emergency-department visits and rehospitalizations. Increasing substance use disorder treatment in this population must be a priority to improve health

Funding

Veena Manja was supported by the VA Office of Academic Affiliations and VA Health Services Research and Development Service (HSR&D) funds and by the VA VISN21 early career awardprogram.

Author contribution

The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents.

Conflict of Interest

The authors report no conflicts of interest.

VA Disclaimer

The views expressed are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

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