Rates of heart failure associated with the growing illicit use of methamphetamine are rising worldwide according to the latest international data.
The research, published 1 December 2022 in the online journal Heart, found that the prevalence of meth related heart failure (methHF) has risen globally, particularly over the last decade – with a ~500% increase in amphetamine-type stimulant seizures since 2010.
The literature review showed that the average duration of meth use before a diagnosis of heart failure was five years, but in almost one in five (18%) of those who went on to develop heart failure, this occurred within 12 months – and in some cases, heart failure was diagnosed after a single use.
Lead author Dr Veena Manja, from California’s VA Centre for Innovation to Implementation and Stanford University’s Department of Health Policy, explained that methHF was also associated with more severe disease than was seen in people who did not use meth, longer inpatient stays, more hospital readmissions, as well a greater likelihood of other substance abuse, PTSD, depression, other heart complaints and kidney disease.
“And concerningly, increasing incidence of methHF was documented in several studies with a more pronounced increase over the past decade,” Dr Manja said.
“The study from California reported a 585% increase in methHF hospitalisations between 2008 and 2018, and an analysis of the NIS reported a 12-fold increase in annual methHF hospitalisations between 2002 and 2014.
“[Overall], methamphetamine use was a strong predictor for HF hospitalisation, with an incidence rate ratio (IRR) of 1.96 (95% CI) for a hospital admission for HF, which is comparable to an IRR for HF with a diagnosis of atrial fibrillation and ischaemic heart disease.
“MethHF has been reported to be a more severe form of cardiomyopathy with severely reduced left ventricular ejection fraction (LVEF) and increased dilation of the left ventricle (LV), and almost 64% of patients were highly symptomatic at presentation.”
Methamphetamine – also popularly known as ‘crystal meth’ and ‘ice’ – is a synthetic psychostimulant that acts by increasing local neurotransmitter concentration and direct toxicity, and is consumed through a variety of methods, including inhalation, injection, swallowing, smoking, and snorting.
Previously published research has shown that use of the drug was associated with serious health problems, including high blood pressure, heart attack, stroke, and even sudden death, but this is the first comprehensive literature review to investigate the drug’s impact on heart failure.
The team reviewed the findings of 21 relevant observational studies carried out around the world between 1997 and 2020 – 14 studies were based in California, two each from Hawaii and New Zealand, one from Australia, one from Germany, and another based on data from the US National Inpatient Sample (NIS).
The number of patients included ranged from 20 to 1655 in case-control and cohort studies and 4265/6625 in administrative database studies, with the mean age of participants between 35 to 60.7 years – most of whom were male (57% to 99%).
Reported routes of administration ranged from inhalation (35%), intravenous injection (30%) and oral consumption (25%) in one study; to smoking (64.3%) followed by snorting (32.9%) in another, with reported frequency among participants ranging from daily to every other week, and a total monthly dose of 0.35 – 24.5 g.
To put that in perspective, in Australia, before the pandemic, the average ‘hit’ of 0.1g of methamphetamine had an estimated street value of $50, bringing the monthly cost associated with the highest level of consumption to nearly $12,250 AUD.
“Treating meth heart failure is also expensive: inpatient data for California indicate that annual charges rose by 840% from $41.5 million in 2008 to $390.2 million in 2018,” Dr Manga said.
“This compares with an equivalent rise of 82% (from $3.5 billion to $6.8 billion) for all heart failure cases.”
The review also pointed out that absolute numbers of MethHF can be expected to increase due the increasing use of high-potency methamphetamine around the world, and there is an urgent need for well-designed prospective studies of meth users to build an accurate evidence base for the effective prevention and treatment of methHF.
“Assessing contribution of social determinants of health to methamphetamine use is central to design successful treatment options and mitigate disparities,” Dr Manja said.
“The combination of sociodemographic factors including homelessness, lack of health insurance, associated mental health conditions and concomitant polysubstance use make treatment of MU disorder challenging.
“Due to the complex behavioural and social effects of methamphetamine addiction, these patients may need support beyond that traditionally offered in heart failure treatment programmes.
“Clinicians from diverse disciplines including cardiology, primary care, psychology, addiction treatment and social services need to synchronise their efforts to support individuals with MethHF overcome the social and structural barriers to recovery.”