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Too much heterogeneity: envisioning a new approach to methamphetamine associated heart failure
  1. Jonathan D Davis
  1. Cardiology, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Jonathan D Davis, Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Building 5, Room 5G1, San Francisco, California 94110, USA; jonathan.davis{at}

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Methamphetamine use is rising nationally,1 2 and with it the incidence of its many cardiopulmonary complications.3 Patients with cardiomyopathy and heart failure due to methamphetamine (MethHF) use are at an increased risk of acute care utilisation (eg, emergency department, inpatient hospitalisation), morbidity and mortality.4 In California, methamphetamine associated admissions increased from 1.2% of all hospitalisations in 2008 to 8% in 2018, a 600% increase.5 Methamphetamine use was an independent predictor of heart failure readmission (OR 3.62, 95% CI 1.40 to 9.38) at our safety-net hospital in San Francisco.6

Barriers to effective treatment of cardiomyopathy due to stimulant use are many: the exact pathophysiology, dose–response and incidence are unknown, continued drug use both drives further disease progression and impedes medical care engagement, and there are limited effective treatment options to reduce use. Co-occurring mental health and other substance use issues and under-resourced socioeconomic and social support (eg, unstable housing, food insecurity, etc) all obstruct outpatient care delivery. These social determinants of health disproportionately affect this population, playing a large role in the elevated risks of hospitalisation for heart failure, morbidity and mortality. Also, the stigma associated with stimulant use too often negatively biases providers, further estranging the care alliance. Rates of acute care utilisation (urgent care, emergency department) are disproportionately high while …

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  • Contributors JDD is the sole author of this editorial.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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