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Methamphetamine-associated heart failure: a systematic review of observational studies
  1. Veena Manja1,2,
  2. Ananya Nrusimha3,
  3. Ya Gao4,
  4. Aleesha Sheikh4,
  5. Mark McGovern5,
  6. Paul A Heidenreich1,5,
  7. Alex Tarlochan Singh Sandhu5,
  8. Steven Asch1,5
  1. 1 VA Center for Innovation to Implementation, Menlo Park, California, USA
  2. 2 Department of Health Policy, Stanford University, Stanford, California, USA
  3. 3 School of Medicine, UC Davis, Davis, California, USA
  4. 4 McMaster University, Hamilton, Ontario, Canada
  5. 5 Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Dr Veena Manja, VA Center for Innovation to Implementation, Menlo Park, California, 94025, USA; veena.manja{at}


Objective To conduct a systematic review of observational studies on methamphetamine-associated heart failure (MethHF) .

Methods Six databases were searched for original publications on the topic. Title/abstract and included full-text publications were reviewed in duplicate. Data extraction and critical appraisal for risk of bias were performed in duplicate.

Results Twenty-one studies are included in the final analysis. Results could not be combined because of heterogeneity in study design, population, comparator, and outcome assessment. Overall risk of bias is moderate due to the presence of confounders, selection bias and poor matching; overall certainty in the evidence is very low. MethHF is increasing in prevalence, affects diverse racial/ethnic/sociodemographic groups with a male predominance; up to 44% have preserved left-ventricular ejection fraction. MethHF is associated with significant morbidity including worse heart failure symptoms compared with non-methamphetamine related heart failure. Female sex, methamphetamine abstinence and guideline-directed heart failure therapy are associated with improved outcomes. Chamber dimensions on echocardiography and fibrosis on biopsy predict the extent of recovery after abstinence.

Conclusions The increasing prevalence of MethHF with associated morbidity underscores the urgent need for well designed prospective studies of people who use methamphetamine to accurately assess the epidemiology, clinical features, disease trajectory and outcomes of MethHF. Methamphetamine abstinence is an integral part of MethHF treatment; increased availability of effective non-pharmacological interventions for treatment of methamphetamine addiction is an essential first step. Availability of effective pharmacological treatment for methamphetamine addiction will further support MethHF treatment. Using harm reduction principles in an integrated addiction/HF treatment programme will bolster efforts to stem the increasing tide of MethHF.

  • Cardiomyopathy, Dilated
  • Heart Failure, Systolic
  • Heart Failure, Diastolic
  • Systematic Reviews as Topic

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  • Contributors VM conceptualised the study, submitted the protocol to Prospero, formulated and operationalised the literature search, reviewed the title, abstract and full texts of publications, contributed to the data abstraction, data analysis and risk of bias assessments, drafted the initial manuscript and worked with the other authors to edit the manuscript to the final version. AN, YG and AS reviewed the title, abstract and full texts of publications, contributed to the data abstraction and risk of bias assessments, and provided input on the manuscript MMG, PAH, ATSS and SA contributed to the study methods, review of the data and writing of the manuscript.

  • Funding The authors have 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 Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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