Methamphetamine-associated heart failure: Clinical characteristics and outcomes in a safety net population.

The study was done in one municipal health system with a strong public insurance system, so results may not apply elsewhere. Data came from medical records and billing codes, and methamphetamine dose, duration, timing relative to heart failure, heart failure severity, and treatment adherence were not available. Methamphetamine use was not separated from other causes of heart failure; the study looked at the total effect among people with heart failure. Loss of follow-up was high, and it was greater among those without methamphetamine use. Readmissions were counted only within the municipal health system, so admissions elsewhere may have been missed. Mortality was matched through national and hospital records for 70% of participants; others were followed until last contact. Adjusted analyses showing lower mortality with methamphetamine use cannot establish a beneficial effect because of residual confounding and no formal mediation analysis.

The supplied text reports no funding source. Dr. Hsue received honoraria from Merck and Gilead, not related to this work. Dr. Thakkar is a Clinical Affairs fellow at Element Science, Inc, not related to this work. All other authors declared no conflicts.

Do not conclude that methamphetamine use lowers mortality or improves heart failure outcomes. The primary mortality comparison was null, and the lower mortality in adjusted analyses is an association that may reflect confounding, more health-system contact, or changes in substance use.