Division of Cardiology (S.X.Z., A.D., A.S.), Santa Clara Valley Medical Center, San Jose, CA.
Center for Population Health Improvement, County of Santa Clara, San Jose, CA (K.K.).
Circ Cardiovasc Qual Outcomes. 2021 Jul;14(7):e007638. doi: 10.1161/CIRCOUTCOMES.120.007638. Epub 2021 Jul 13.
Methamphetamine-associated cardiomyopathy/heart failure (MethHF) is an increasingly recognized disease entity in the context of a rising methamphetamine (meth) epidemic that most severely impacts the western United States. Using heart failure (HF) hospitalization data from the Office of Statewide Health Planning and Development, this study aimed to assess trend and disease burden of MethHF in California.
Adult patients (≥18 years old) with HF as primary hospitalization diagnosis between 2008 and 2018 were included in this study. The association with Meth (MethHF) and those without (non-MethHF) were determined by meth-related -based secondary diagnoses. Statistical significance of trends in age-adjusted rates of hospitalization per 100 000 adults were evaluated using nonparametric analysis.
Between 2008 and 2018, 1 033 076 HF hospitalizations were identified: 42 565 were MethHF (4.12%) and 990 511 (95.88%) were non-MethHF. Age-adjusted MethHF hospitalizations per 100 000 increased by 585% from 4.1 in 2008 to 28.1 in 2018, while non-MethHF hospitalizations decreased by 6.0% from 342.3 in 2008 to 321.6 in 2018. The rate of MethHF hospitalization increase more than doubled that of a negative control group with urinary tract infection and meth-related secondary diagnoses (7.82-fold versus 3.48-fold, <0.001). Annual inflation-adjusted hospitalization charges because of MethHF increased by 840% from $41.5 million in 2008 to $390.2 million in 2018, as compared with an 82% increase for all HF hospitalization from $3.503 billion to $6.376 billion. Patients with MethHF were significantly younger (49.64±10.06 versus 72.20±14.97 years old, <0.001), predominantly male (79.1% versus 52.4%, <0.001), with lower Charlson Comorbidity Index, yet they had longer length of stay, more hospitalizations per patient, and more procedures performed during their stays.
MethHF hospitalizations increased sharply during the study period and contributed significantly to the HF hospitalization burden in California. This emerging HF phenotype, which engenders considerable financial and societal costs, calls for an urgent and concerted public health response to contain its spread.
在不断上升的冰毒（meth）流行趋势下，冰毒相关的心肌病/心力衰竭（MethHF）作为一种日益被认识的疾病实体，对美国西部的影响最为严重。本研究利用州卫生规划与发展办公室的心力衰竭（HF）住院数据，旨在评估加利福尼亚州 MethHF 的趋势和疾病负担。
本研究纳入了 2008 年至 2018 年间以 HF 为主要住院诊断的成年患者（≥18 岁）。通过基于与 meth 相关的次要诊断来确定与 Meth（MethHF）和非 Meth（非 MethHF）的关联。使用非参数分析评估每 10 万成年人住院率的年龄调整趋势的统计学意义。
在 2008 年至 2018 年间，共确定了 1033076 例 HF 住院患者：42565 例为 MethHF（4.12%），990511 例为非 MethHF（95.88%）。每 10 万成年人的 MethHF 住院率从 2008 年的 4.1 上升到 2018 年的 28.1，增加了 585%，而非 MethHF 住院率从 2008 年的 342.3 下降到 2018 年的 321.6，降低了 6.0%。MethHF 住院率的增长率是尿路感染和与 meth 相关的次要诊断的负对照组的两倍多（7.82 倍对 3.48 倍，<0.001）。由于 MethHF，每年通胀调整后的住院费用从 2008 年的 4150 万美元增加到 2018 年的 3.902 亿美元，增长了 840%，而所有 HF 住院费用从 35.03 亿美元增加到 63.76 亿美元，增长了 82%。MethHF 患者明显更年轻（49.64±10.06 岁对 72.20±14.97 岁，<0.001），主要是男性（79.1%对 52.4%，<0.001），Charlson 合并症指数较低，但住院时间更长，每位患者的住院次数更多，住院期间的治疗程序更多。
在研究期间，MethHF 的住院人数急剧增加，对加利福尼亚州的心力衰竭住院负担有显著贡献。这种新出现的心力衰竭表型导致了相当大的经济和社会成本，需要紧急和协调一致的公共卫生应对措施来遏制其传播。
