患有心力衰竭和吸食冰毒的患者的临床特征和结局。
Clinical Characteristics and Outcomes of Patients With Heart Failure and Methamphetamine Abuse.
机构信息
Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California.
Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California.
出版信息
J Card Fail. 2020 Mar;26(3):202-209. doi: 10.1016/j.cardfail.2019.10.002. Epub 2019 Oct 13.
BACKGROUND
Despite a global epidemic of methamphetamine abuse, methamphetamine-associated heart failure (MethHF) remains poorly understood. We sought to evaluate characteristics and outcomes for patients with MethHF.
METHODS
We reviewed the electronic health records of the University of California, San Diego, from 2005 to 2016. We compared characteristics and outcomes between 896 patients with MethHF and 20,576 patients with heart failure (HF) identified using diagnosis codes, urine toxicology, and natriuretic peptides.
RESULTS
Compared with HF, patients with MethHF were younger (50±10 vs 67±16 years), predominantly male (72% vs 54%), and had more psychiatric and substance use comorbidities, including mood/anxiety disorders (29% vs 16%) and opioid use (44% vs 7%). MethHF had a higher 5-year HF readmission rate (64±4% vs 45±1%; hazard ratio [HR] 1.53, P < .001) and a lower 10-year total mortality rate (25±3% vs 28±1%; HR 0.85, P = .09). Predictors of poor outcomes included mood/anxiety disorders (HF readmission HR 1.41, P = .04) and opioid abuse (mortality HR 1.52, P = .04).
CONCLUSIONS
Patients with MethHF are frequently encumbered by psychiatric and substance abuse comorbidities, and carry a substantial risk of HF readmission and mortality. Comprehensive efforts are needed to stem this emerging epidemic.
背景
尽管冰毒滥用在全球范围内流行，但与冰毒相关的心力衰竭（MethHF）仍然知之甚少。我们试图评估患有 MethHF 的患者的特征和结局。
方法
我们回顾了 2005 年至 2016 年期间加利福尼亚大学圣地亚哥分校的电子健康记录。我们比较了 896 例 MethHF 患者和 20576 例通过诊断代码、尿液毒物学和利钠肽确定的心力衰竭（HF）患者的特征和结局。
结果
与 HF 相比，MethHF 患者更年轻（50±10 岁 vs 67±16 岁），主要为男性（72% vs 54%），并有更多的精神和物质使用合并症，包括情绪/焦虑障碍（29% vs 16%）和阿片类药物使用（44% vs 7%）。MethHF 的 HF 5 年再入院率较高（64±4% vs 45±1%；危险比[HR]1.53，P<0.001），10 年总死亡率较低（25±3% vs 28±1%；HR 0.85，P=0.09）。不良结局的预测因素包括情绪/焦虑障碍（HF 再入院 HR 1.41，P=0.04）和阿片类药物滥用（死亡率 HR 1.52，P=0.04）。
结论
患有 MethHF 的患者经常伴有精神和物质滥用合并症，HF 再入院和死亡的风险很大。需要采取综合措施来遏制这一新兴的流行。
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