Abstract 13760: Methamphetamine Use is Common Among Patients with Left Ventricular Systolic Dysfunction

Abstract

Background: Methamphetamine (meth) use is a major public health problem in the United States. Approximately 13 million Americans over age 12 have used meth at least once and 353,000 were current users in 2010. Meth is anecdotally associated with severe heart failure but there are few studies that have systematically investigated this relationship. We sought to test the hypothesis that meth users with heart failure differ from other patients with heart failure.

Methods: We performed a cross sectional study of patients with an echocardiogram at San Francisco General Hospital between July 2007 and Sept 2009 showing new moderate-to severe or severe left ventricular systolic dysfunction. Data was collected by retrospective chart review. Cardiomyopathy was determined to be non-ischemic (NICM) based on the clinical history or if there was no coronary stenosis >70% on coronary angiography. Meth use was determined by review of urine toxicology and patient history. The Mann Whitney and Fischer’s exact test were used to compare continuous and categorical data respectively. Findings: A total of 134 patients were included in the analysis. Eighty-eight had a final diagnosis of NICM and 46 had ischemic cardiomyopathy (ICM). NICM was attributed to stimulant drug use in 49 patients and specifically to meth in 14 patients (16%). Compared to other patients with NICM, patients with NICM who used meth were younger (46 vs. 59 years old p<0.005), had more hospital admissions (3.2 vs. 0.8 p<0.005) and were more likely to be homeless (OR 6, 95% CI 1.6-22.5). There were no differences in gender or race, systolic blood pressure, creatinine, invasive hemodynamics, NYHA classification, need for ICU admission or discharge medications. There was a non-significant trend towards increased in-hospital death among meth users (OR 4.8, 95% CI 0.92 to 25.1).

Conclusions: Meth use is common among patients with left ventricular systolic dysfunction at our institution. Meth users were younger, admitted more frequently and had a trend towards increased odds of in-hospital death. Further study is needed to better understand the cardiovascular effects of meth use and to determine if there is a causal relationship between meth use and NICM.