Meth-Related Heart Failure Worse, But Responds Well to Meds if Abuse Stops

November 14, 2019

Patients with heart failure (HF) from methamphetamine abuse (meth-HF) tend to be sicker and have worse cardiac function than those with other forms of HF, but can respond to HF management as least as well if they also stop taking methamphetamines, suggests an observational study.

"Even in just the short time of the study, with up to a year follow-up, stopping methamphetamine made a significant improvement on their heart," Harpreet S. Bhatia, MD, University of California, San Diego, told | Medscape Cardiology.

As long as they were also prescribed guideline-based HF drug therapy, they improved both clinically and echocardiographically on par with treated HF patients who hadn't been meth abusers, said Bhatia, who is slated to present the study November 16 at the American Heart Association Scientific Sessions 2019.

Bhatia and his colleagues compared 74 patients with meth-HF and 83 contemporaneous non-meth-using patients with other forms of HF, who served as the control group.

Meth-HF patients were younger (mean age, 51.6 vs 61.3 years; P < .001) and more likely to be male (74.3% vs 54.2%; P = .009). They were less likely to have a "normal" left ventricular ejection fraction (LVEF), that is greater than 50% (37.8% vs 51.8%; P = .011).

Among the remaining patients with "reduced" LVEF, those with a history methamphetamine abuse had a lower mean LVEF and greater ventricular remodeling by echocardiography.

Baseline Echocardiographic Differences, Patients With Meth-HF vs Non-Meth-HF, Limited to LVEF ≤50%
End Point Meth-HF (n = 74) Non-Meth-HF (n = 83) P Value
LVEF (%) 28.17 35.30 .001
LVEDD (cm) 5.97 5.34 .002
LVESD (cm) 5.04 4.21 .001
LVEDD = left ventricular end diastolic diameter
LVESD = left ventricular end systolic diameter

Among patients with meth-HF at baseline, those who stopped using meth during follow-up and had 1-year echocardiograms showed significant gains in LVEF. It remained stable or worsened for those who continued meth use.

Changes in LVEF Over 1 Year, Subgroup With Serial Echocardiography, by Meth-Use Status
End Point Continued Meth Use (n = 19) P Value* Cessation of Meth Use (n = 27) Meth Nonusers (n = 55)
LVEF absolute change (percentage points) –1.71 .017 +10.64 +10.78
LVEF relative change (%) –3.92 .023 +43.3 +37.9
≥10% improvement in LVEF (%) 14 <.001 79 74
*Continued vs cessation of meth use

Of note, LVEF improved to similar degrees for those who stopped using meth and those who had been users.

The meth-HF group, compared with the non-meth-HF group, had significantly more all-cause and HF-related hospital admissions over the follow-up; both end points were significantly reduced for those who stopped vs continued meth use. Mortality was significantly increased for patients with non-meth-related HF.

Clinical Outcomes by Meth-Use Status
End Point Continued Meth Use (n = 19) Cessation of Meth Use (n = 27) Meth Nonusers (n = 78)
HF admissions per year (n) 1.89 1.30¹ 0.31²
All-cause admissions per year (n) 2.63 3.19 1.21²
Mortality (mean %) 0 0 14.1³
1. 0.024 vs continued meth use
2. <.001 vs all meth-HF patients
3. 0.028 vs all meth-HF patients

About 40% to 50% of patients in each of the groups had been prescribed beta blockers and either ACE inhibitors or angiotensin receptor blockers (ARBs). Rates were nonsignificantly different for those who had stopped or continued using meth, evidence that the improvements seemed at least in part from going off meth, not just from medical therapy, Bhatia observed.

Consistent with clinical experience, meth-HF patients overall were more likely to be alcohol abusers (18.9% vs 2.4%; P = .001) and opioid users (50.0% vs 9.6%; P < .001). But among those with HF and reduced LVEF, Bhatia said, there were no such significant differences between the groups.

One of the study's messages for clinical practice, Bhatia said, is that patients with HF who are methamphetamine abusers "are not a lost cause, that if you can get them somehow to stop using meth — which is a very difficult thing to do — they demonstrate significant improvement. That could be a source of reassurance for providers that the effort is worth making, and even potentially motivation for patients."

But, "it comes down to the patient being able to stop," he emphasized, "with the caveat that everyone needs to be on guideline-directed medical therapy."

Bhatia had no relevant conflicts; disclosures for the coauthors are in the abstract.

American Heart Association (AHA) Scientific Sessions 2019: Abstract Sa2070. Scheduled presentation November 16, 2019.

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