Methamphetamine abuse exacerbates HF in growing number of veterans

Methamphetamine abuse (MA) is on the rise among veterans with concomitant heart failure (HF), according to a recent analysis published in the American Journal of Cardiology

Marin Nishimura, MD, of the University of California, San Diego, and colleagues retrospectively studied veterans with HF treated between 2005 and 2015 at the VA Medical Center in San Diego. The authors said methamphetamine abuse is increasing among vets and among the wider U.S. population, but while it’s been linked to CV complications like cardiomyopathy and pulmonary hypertension, it’s been poorly characterized in certain groups.

That includes veterans with heart failure, 9,491 of whom were included in Nishimura et al.’s analysis. Of the study population, 429 subjects—around 4.5% of the total pool—also reported a history of methamphetamine abuse.

The researchers found the incidence of MA in veterans with HF doubled between 2006 and 2015, from 3.4% to 6.7%. Of the vets who reported methamphetamine abuse, 106 were hospitalized for HF within the study period and were measured against a corresponding population of veterans with HF but without MA. Compared to vets with HF, those with both HF and MA:

  • Were younger (on average 61 years old vs. 72 years old)
  • More frequently presented with comorbid PTSD (16.8% vs. 4.4%)
  • Were more often depressed (28.7% vs. 11%)
  • Were more likely to be homeless (27.9% vs. 8.9%)
  • Were more often unemployed (55.8% vs. 30%).

Despite their younger age, vets with both HF and MA saw higher rates of HF readmissions and emergency room visits—49% compared to 38% in veterans with HF alone. They were also 11% more likely than their counterparts to die within six months of the study’s baseline and more often used other drugs like cocaine, opioids, heroin and alcohol.

“Taken together, these specific demographic and socioeconomic characteristics of the [HF and MA] cohort make them vulnerable to continued MA,” Nishimura and co-authors wrote in AJC. “Veterans, in particular, are vulnerable to mental health issues and substance abuse, and portend a worse outcome when they occur together. The combat experience is also tied to subsequent unemployment and homelessness, which may further contribute to development of psychiatric comorbidities and substance abuse in this patient population.”

The authors said both study groups presented with similar rates of diabetes, chronic kidney disease, hypertension, history of ventricular tachycardia and previous percutaneous coronary intervention. Prevalence of atrial fibrillation, cerebral vascular accidents, hyperlipidemia and history of coronary artery bypass grafting, on the other hand, was lower in the cohort with both HF and MA.

Nishimura and colleagues said lower rates of some comorbidities in the MA group are likely attributable to that group’s younger average age. Their results echoed those of other studies that have suggested a higher incidence of MA in younger HF patients.

“Clinical outcomes were poor in veterans with [HF and MA], despite a younger average age compared with veterans in the HF cohort,” the authors wrote. “Given the rising prevalence of MA in veterans with HF, greater recognition of the complex underpinnings of this disease process may be needed to improve clinical outcomes in this patient population.”