# Hospitalized patients and stimulant use-associated heart failure: importance of ejection fraction and related risk factors

## TL;DR

Stimulant use is linked to a higher risk of heart failure with reduced ejection fraction, especially in middle-aged males and Black patients.

## Contribution

This study identifies HFrEF as the HF subtype most associated with stimulant use and highlights demographic and regional risk factors.

## Key findings

- Stimulant use is more likely associated with HFrEF (OR = 1.97) than HFpEF (OR = 0.96).
- Stimulant-related HF is most common in males, middle-aged individuals, Black patients, and those in the South or West regions.
- Hospitalizations for stimulant-related HF increased significantly from 2008 to 2020.

## Abstract

Methamphetamine and cocaine use are known risk factors for heart failure (HF). Previous studies focused on HF cases identified as either methamphetamine or cocaine-induced HF with no study identifying the HF subtype most associated with stimulant use. Our study hypothesizes that stimulant users have a higher odds of developing HFrEF than HFpEF. Our study also compares demographic and comorbidities between the HF subtypes.

National Inpatient Sample data from 2008 to 2020 were used to identify hospital admissions among stimulant users with HF. The chi-square test for categorical variables and t-test for continuous variables was used for the weighted sample. P-value was found by linear trend analysis. The trend stratified by age, sex, race, and United States region (defined by the US Census Bureau) was analyzed by the Cochran-Armitage trend test. A generalized linear model determined the HF subtype related to stimulant use adjusted for traditional risk factors, and another model estimated vulnerable patient characteristics.

Stimulant use was more likely to be associated with HFrEF (OR = 1.97, CI 1.93–2.01), while less associated with HFpEF (OR = 0.96, CI 0.94–0.98). HF among stimulant users was common (p < 0.001) in males, those aged 41–64, Black patients, Medicaid users, those in the <50 percentile income, and the South or West regions. Stimulant-related HF hospitalizations increased significantly from 2008 to 2020 for all subcategories (p < 0.001).

Stimulant use is positively associated with HFrEF, with the highest risk being in those middle-aged, male, Black, or covered by Medicaid. The higher likelihood of traditional risk factors for HF in stimulant-related HF supports the hypothesis that stimulants induce multifactorial damage to the cardiovascular system.