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Abstract
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Cardiomyopathy-Associated Hospital Admissions Among Methamphetamine Users
JACC: Advances, Volume 3, Issue 7, Part 2, July 2024, Pages 100840
Zaki Al-Yafeai, Shafaqat Ali, Jimmy Brown, Maamannan Venkataraj, Md. Shenuarin Bhuiyan, Abu Saleh Mosa Faisal, Kenneth Densmore, Nicholas E. Goeders, Steven R. Bailey, Steven A. Conrad, John A. Vanchiere, A. Wayne Orr, Christopher G. Kevil, Mohammad Alfrad Nobel Bhuiyan
The epidemic of methamphetamine use is growing at an alarming rate and is accompanied by a significant burden of cardiovascular sequelae. In the United States, between 2015 and 2019, the prevalence of methamphetamine use increased by 43%, casting its shadow over 2 million people.1 The epidemic has disproportionately affected racial minority populations and those with lower socioeconomic status and housing instability.2 The Centers for Disease Control reports that overdose deaths involving methamphetamine increased 50-fold over the past 2 decades.3 In regard to cardiovascular disease, hospitalizations for methamphetamine cardiomyopathy with associated HF (MethHF) in California increased by 585% between 2008 and 2018, with inflation-adjusted hospitalization charges due specifically to MethHF increasing by 840%--a rate more than 10-times greater than that for all heart failure admissions.4
This recent analysis conducted by Al-Yafeai et al5 in this issue of JACC: Advances provides key epidemiological insights into methamphetamine-associated cardiomyopathy in the United States. This study also highlights the geographical, sex, and race/ethnic disparities in cardiomyopathy-associated hospital admissions among people who use methamphetamine. A prior study leveraging the National Inpatient Database found that MethHF hospitalizations were increasing at an exponential rate between 2002 and 2014, particularly on the West Coast and among men, younger patients, urban hospitals, unstably housed populations, and patients who were uninsured or received Medicaid.6 An increased relative prevalence of MethHF was observed among patients of Hispanic, Native American, and Asian/Pacific Islander descent.6 The present study extends the prior analysis by applying rigorous statistical methods and including data from all 50 states from 2008 to 2020. Al-Yafeai and others report a dramatic rise in hospitalizations for MethHF in comparison to overall admissions for heart failure, which increased from 2% in 2008 to nearly 20% in 2020. They also contextualize these findings by demonstrating disproportionate increases in hospitalizations for MethHF in the West and Southwestern U.S., among younger men (ie, those under age 65 years) and among people of Hispanic, Native American, and Asian descent compared with non-Hispanic White and African American populations.
This work should lead us to interrogate why certain geographic areas and populations suffer a disproportionate burden of MethHF and the ways in which local public policies, differential availability of psychostimulant drugs, and socioeconomic disparities have shaped the epidemic. In devising strategies to support the prevention and treatment of MethHF, the findings of Al-Yafeai et al reinforce the importance of developing targeted interventions. ...
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