Thakkar Anjali B, Durstenfeld Matthew S, Ma Yifei, Win Sithu, Hsue Priscilla Y
Division of Cardiology at ZSFG and Department of Medicine, University of California, San Francisco (UCSF), USA.
Division of Cardiology at ZSFG and Department of Medicine, University of California, San Francisco (UCSF), USA.
Heart Lung. 2025 Mar-Apr;70:214-222. doi: 10.1016/j.hrtlng.2024.11.012. Epub 2024 Dec 28.
Methamphetamine use is increasing and is associated with development of heart failure (HF). However, clinical characteristics and outcomes have not been well-described.
To compare outcomes among individuals with HF with and without methamphetamine use in a safety-net setting.
This retrospective matched cohort study included individuals with HF with history of methamphetamine use and age, gender-, and year-matched controls without history of methamphetamine use in a municipal health system from 2001 to 2019. One thousand seven hundred seventy-one individuals with methamphetamine use and HF and 3,542 age, sex, and year-of-HF-diagnosis matched controls with HF without methamphetamine use were included. The primary outcome was all-cause mortality. Secondary outcomes included time to HF hospitalization, 30-day, 90-day, and one-year HF, and all-cause readmissions.
The median age of the cohort was 52.1 years and 22.6 % were female. Black/African American was the most common racial identity (methamphetamine: 49.1 %; no methamphetamine: 33 %). There was no significant difference in mortality between groups (40% vs 36.6 %,HR 1.00,95 % CI 0.91,1.10,p = 1.00). A subset had an index HF hospitalization (n = 1,404, 26.4 %) during the study period, including 637 (35.9 %) with history of methamphetamine use and 767 (21.7 %) without history of methamphetamine use (relative risk 1.66,95 % CI 1.52-1.81,p < 0.0001). Among those who were ever hospitalized for HF, individuals with methamphetamine use had increased risk of HF and all-cause readmission at 30 days (RR 1.92,95 % CI 1.36-2.70,p < 0.001), 90 days (RR 1.69,95 % CI 1.35-2.12,p < 0.001), and one year (RR 1.61,95 % CI 1.36-1.91,p < 0.001).
Despite having higher all-cause and HF readmission risk, individuals with methamphetamine-associated HF did not have higher mortality risk.
甲基苯丙胺的使用正在增加，且与心力衰竭（HF）的发生有关。然而，其临床特征和预后尚未得到充分描述。
在安全网环境中比较有和没有使用甲基苯丙胺的心力衰竭患者的预后。
这项回顾性匹配队列研究纳入了2001年至2019年在市卫生系统中有甲基苯丙胺使用史的心力衰竭患者以及年龄、性别和年份匹配的无甲基苯丙胺使用史的对照者。纳入了1771名有甲基苯丙胺使用史且患有心力衰竭的患者以及3542名年龄、性别和心力衰竭诊断年份匹配的无甲基苯丙胺使用史的心力衰竭对照者。主要结局是全因死亡率。次要结局包括心力衰竭住院时间、30天、90天和1年的心力衰竭情况以及全因再入院情况。
队列的中位年龄为52.1岁，22.6%为女性。黑人/非裔美国人是最常见的种族身份（甲基苯丙胺使用者：49.1%；无甲基苯丙胺使用者：33%）。两组之间的死亡率无显著差异（40%对36.6%，HR 1.00，95%CI 0.91，1.10，p = 1.00）。在研究期间，一部分患者有首次心力衰竭住院（n = 1404，26.4%），其中有637名（35.9%）有甲基苯丙胺使用史，767名（21.7%）无甲基苯丙胺使用史（相对风险1.66，95%CI 1.52 - 1.81，p < 0.0001）。在那些曾因心力衰竭住院的患者中，有甲基苯丙胺使用史的患者在30天（RR 1.92，95%CI 1.36 - 2.70，p < 0.001）、90天（RR 1.69，95%CI 1.35 - 2.12，p < 0.001）和1年（RR 1.61，95%CI 1.36 - 1.91，p < 0.001）时发生心力衰竭和全因再入院的风险增加。
尽管有甲基苯丙胺相关性心力衰竭的患者全因和心力衰竭再入院风险较高，但死亡率风险并不更高。
