Methamphetamine-Associated Heart Failure Placing Major Burden on California Health Care Systems

Susan Zhao, MD

New research from a team based out of San Jose, CA is providing detail into the impact methamphetamine-associated heart failure has had in California for more than a decade.

A look at statewide heart failure data from 2008-2018, results demonstrate a more than 500% increase in the incidence of methamphetamine-associated heart failure and provide insight into the 840% jump in hospitalization costs associated with these events —from $41.5 million in 2008 to $390.2 million in 2018.

"Our study results should bring urgent attention to this insidious yet rapidly growing form of severe heart failure - methamphetamine-related heart failure, which is taking the lives of young people, straining health care resources and threatening to spread like wildfire in California, the West and to the rest of the nation," said lead author Susan X. Zhao, MD, Cardiologist at Santa Clara Valley Medical Center in San Jose, California, in a statement. "California is seeing a resurgence of methamphetamine use, and the problem has been made drastically worse in recent years by the increase in purer, more potent methamphetamine throughout our communities."

As use of methamphetamine ballooned in the past decade and a half in California, reports suggest the incidence of methamphetamine-associated heart failure hospitalizations has increased as well, but little data has been produced beyond observational reports on the subject. To provide a greater evidence base related to the increased prevalence of methamphetamine-associated heart failure, Zhao and colleagues from northern California-based institutions designed their study to examine trends from data provided by the State of California Health and Human Services Agency’s Office of Statewide Health Planning and Development (OSHPD).

The primary outcomes of interest for the investigators’ analyses included age-adjusted hospitalization rates per 100,000 adults, crude hospitalization rate based on race/sex subgroups, inflation-adjusted annual heart failure hospitalization charges, and temporal or geospatial patterns in distribution of methamphetamine-related heart failure hospitalizations. Investigators pointed out the use of OSHPD data allowed for adjustment for confounders including county, zip code or residence, race/ethnicity, hospital county/zip codes, adjusted length of stay, primary and other procedures performed, and source of payment.

From 2008-2018, investigators identified 4,808,506 adults heart failure hospitalizations. Of these, 1,033,076 hospitalizations had heart failure listed as the primary diagnosis, including 42,565 considered methamphetamine-associated heart failure.

The rate of age-adjusted methamphetamine-associated heart failure hospitalizations increased from 4.1 per 100,000 in 2008 to 28.1 per 100,000 in 2018, which is reflective of a 585% increase. In contrast, the rate of non-methamphetamine-associated heart failure hospitalizations was 342.3 per 100,000 in 2008 and decreased by 6.0% to 321.6 in 2018. Investigators pointed out the rate of increase seen with methamphetamine-associated heart failure hospitalizations was more than double that of a negative control group with urinary tract infection and meth-related secondary diagnoses (7.82-fold vs 3.48-fold, P <.001).

When assessing the financial impact, results indicated the annual inflation-adjusted hospitalization charges as a result of methamphetamine-associated heart failure hospitalizations increased by 840% from $41.5 million in 2008 to $390.2 million in 2018. In comparison, the charges attributable to all heart failure hospitalizations increased just 82% from $3.503 billion in 2008 to $6.376 billion in 2018.

Further analysis indicated patients with methamphetamine-associated heart failure were significantly younger, more likely to be male, and have a lower Charlson Comorbidity Index than those with non-methamphetamine-associated heart failure. Additionally, those with methamphetamine-associated heart failure had longer length of stay, more hospitalizations per patient, and greater number of procedures performed during their stays.

In an editorial comment, Pavan Reddy, MD, and Uri Elkayam, MD, commend Zhao and colleagues for their study’s addition to the existing knowledge base, but also note the need for greater research and interventions to mitigate the impact of methamphetamine-associated heart failure hospitalizations.

“The rising prevalence of MethHF should ring alarm bells but also signals an opportunity. Until recently, MethHF was highlighted only in the form of isolated case reports but is now seen regularly in high usage areas. Although this study makes strides in underscoring the potential societal impact of this protracted illness, prospective data from larger cohorts may help clarify questions left unanswered by the current study,” wrote Reddy and Elkayam.

This study, “Socioeconomic Burden of Rising Methamphetamine-Associated Heart Failure Hospitalizations in California From 2008 to 2018,” was published in Circulation: Cardiovascular Quality and Outcomes.