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Meth cessation may reverse drug-induced HF

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Harpreet S. Bhatia

PHILADELPHIA — Among methamphetamine users with drug-induced HF, stopping use conferred improved HF symptoms, according to data presented at the American Heart Association Scientific Sessions.

“We see a lot of methamphetamine abuse resulting in heart failure in San Diego, and it is only increasing,” Harpreet S. Bhatia, MD, cardiovascular fellow at the University of California, San Diego, told Healio. “Data on this condition are limited, especially in terms of progression over time and its potential reversibility. We decided to undertake this study because of how often we see these types of patients, and because of how many unanswered questions there are.”

Bhatia and colleagues compared 74 patients with methamphetamine-associated HF with 83 patients treated for HF around the same time without documented methamphetamine use. Compared with nonusers, methamphetamine users were younger, more often men, more likely to abuse alcohol and more likely to use opioids (P < .01 for all).

Among those with reduced left ventricular ejection fraction, methamphetamine users had lower EF (28.2% vs. 35.3%; P < .01) and more LV dilation (5.4 cm vs. 4.9 cm; P < .01), according to the researchers. In addition, methamphetamine users had 1.2 HF readmissions per year compared with 0.3 for nonusers (P < .01).

At 12 months, among those with methamphetamine-associated HF, those who stopped using methamphetamine had lower pro B-type natriuretic peptide levels (4,284 pg/mL vs. 5,209 pg/mL; P = .02), fewer readmissions for HF (1.3 per year vs. 1.9 per year; P = .02) and greater relative improvement in LVEF (43.4% vs. –3.9%; P < .01) compared with those who continued using, Bhatia and colleagues found.

“The most important take-home messages are: Patients with heart failure associated with methamphetamine abuse have evidence of more severe heart failure, even though they tend to be younger than people with other types of heart failure; among those with methamphetamine associated heart failure, cessation of meth was associated with significant improvements in left ventricular function and decreased heart failure admissions over a relatively short period of time; and those patients that stop using meth became similar to patients with nonmethamphetamine-associated heart failure in terms of their improvement,” Bhatia told Healio.

In addition to prescribing guideline-directed HF medical therapy, clinicians should treat the methamphetamine abuse in this population, Bhatia said in an interview.

“Our study provides a potential source of hope and motivation for both providers and patients by showing that cessation of methamphetamine abuse can lead to significant improvement in structural changes in the heart, as well as heart failure admissions,” he said. – by Erik Swain

Reference:

Bhatia HS, et al. Presentation Sa2070. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.

Disclosure: Bhatia reports no relevant financial disclosures.