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Methamphetamine-Associated Heart Failure Hospitalizations Across the United States: Geographic and Social Disparities.

ABSTRACT: Background Although methamphetamine abuse is associated with the development of heart failure (HF), nationwide data on methamphetamine-associated HF (MethHF) hospitalizations are limited. This study evaluates nationwide HF hospitalizations associated with substance abuse to better understand MethHF prevalence trends and the clinical characteristics of those patients. Methods and Results This cross-sectional period-prevalence study used hospital discharge data from the National Inpatient Sample to identify adult primary HF hospitalizations with a secondary diagnosis of abuse of methamphetamines, cocaine, or alcohol in the United States from 2002 to 2014. All 2014 MethHF admissions were separated by regional census division to evaluate geographical distribution. Demographics, payer information, and clinical characteristics of MethHF hospitalizations were compared with all other HF hospitalizations. Total nationwide MethHF hospitalizations increased from 547 in 2002 to 6625 in 2014 with a predominance on the West Coast. Methamphetamine abuse was slightly more common among primary HF hospitalizations compared with all-cause hospitalizations (7.4 versus 6.4 per 1000; Cohen h=0.012; P<0.001). Among HF hospitalizations, patients with MethHF were younger (mean age, 48.9 versus 72.4 years; Cohen d=1.93; P<0.001), more likely to be on Medicaid (59.4% versus 8.8%; Cohen h=1.16; P<0.001) or uninsured (12.0% versus 2.6%; Cohen h=0.36; P<0.001), and more likely to present to urban hospitals (43.8% versus 28.3%; Cohen h=0.32; P<0.001) than patients with non-methamphetamine associated HF. Patients with MethHF had higher rates of psychiatric comorbidities and were more likely to leave the hospital against medical advice. Conclusions MethHF hospitalizations have significantly increased in the United States, particularly on the West Coast. Coordinated public health policies and systems of care are needed to address this rising epidemic.

SUBMITTER: Dickson SD

PROVIDER: S-EPMC8475042 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundNationwide data of the COVID-19 pandemic's impact on Heart Failure (HF) hospitalizations is lacking. We conducted this study to elucidate the impact of the COVID-19 pandemic on HF hospitalizations. Additionally, we assessed the differences in hospitalization characteristics during the pandemic and the impact that a concurrent diagnosis of COVID-19 has on various outcomes and predictors of inpatient mortality among patients admitted for HF.MethodsThe National Inpatient Sample (NIS) database was queried for all hospitalizations with a primary diagnosis of HF between 2017 - 2020. Monthly HF hospitalizations were trended longitudinally over this period. Beginning April 1, 2020, concurrent COVID-19 infections were identified. Subsequently, we stratified HF hospitalizations between April 2020 and December 2020 (HF-2020) based on if concomitant COVID-19 was diagnosed, forming the HF-COVID+ve and HF-COVID-ve groups respectively. HF-2020 was also compared with pre-pandemic HF hospitalizations between April 2019 and December 2019 (HF-2019). Baseline characteristics were compared, and adjusted outcomes were obtained.ResultsDuring the initial COVID-19 surge in April 2020, HF admissions were reduced by 47% compared to January 2020. Following this decline, HF hospitalizations increased but did not reach pre-pandemic levels. HF-2020 admissions had an increased complication burden compared to HF-2019, including acute myocardial infarction (8.9% vs. 6.6%, p<0.005) and pulmonary embolism (4.1% vs. 3.4%, p<0.005) indicating a sicker cohort of patients. HF-COVID+ve hospitalizations had 2.9 times higher odds of inpatient mortality compared to HF-COVID-ve and an increased adjusted length of stay by 2.16 days (p<0.005).ConclusionA pandemic of the same magnitude as COVID-19 can overwhelm even the most advanced health systems. Early resource mobilization and preparedness is essential to provide care to a sick cohort of patients like acute heart failure, who are directly and indirectly effected by the consequences of the pandemic which has worsened hospitalization outcomes.

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Methamphetamine-Associated Heart Failure Hospitalizations Across the United States: Geographic and Social Disparities.

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