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Clinical Differences and Outcomes between Methamphetamine-Associated and Idiopathic Pulmonary Arterial Hypertension in the PHAR. Annals of the American Thoracic Society Kolaitis, N. A., Zamanian, R. T., de Jesus Perez, V. A., Badesch, D. B., Benza, R. L., Burger, C. D., Chakinala, M. M., Elwing, J. M., Feldman, J. n., Lammi, M. R., Mathai, S. C., McConnell, J. W., Presberg, K. W., Robinson, J. C., Sager, J. n., Shlobin, O. A., Simon, M. A., Kawut, S. M., Glidden, D. V., Singer, J. P., De Marco, T. n. 2020

Abstract

Single-center studies demonstrated that methamphetamine use is associated with pulmonary arterial hypertension (Meth-APAH). We used the Pulmonary Hypertension Association Registry to evaluate the national distribution of Meth-APAH, and to compare its impact on patient-reported and clinical outcomes relative to idiopathic PAH.To determine if patients with Meth-APAH differ from those with idiopathic PAH in demographics, regional distribution in the US, hemodynamics, health-related quality of life, PAH-specific treatment, and health care utilization.The Pulmonary Hypertension Association Registry is a US-based prospective cohort of patients new to care at a Pulmonary Hypertension Care Center. The registry collects baseline demographics, clinical parameters, and repeated measures of health-related quality of life, World Health Organization functional class, six-minute walk distance, therapy, and health care utilization. Repeated measures of functional class, health-related quality of life, type of therapy, emergency department visits, and hospitalizations were compared using generalized estimating equations.Of 541 participants included, 118 had Meth-APAH; 83% of Meth-APAH arose in the Western US. The Meth-APAH group was younger, had a poorer socioeconomic status, and lower cardiac index than the idiopathic PAH group, despite no difference in mean pulmonary artery pressure or pulmonary vascular resistance. The Meth-APAH group had a more advanced functional class in longitudinal models (0.22 points greater, 95%CI: 0.07 to 0.37), and worse PAH-specific (emPHasis-10) health-related quality of life (-5.4, 95%CI: -8.1 to -2.8). There was no difference in dual combination therapy, however, participants with Meth-APAH were less likely to be initiated on triple therapy (OR: 0.43, 95%CI 0.24 to 0.77) or parenteral therapy (OR: 0.10, 95%CI 0.04 to 0.24). Participants with Meth-APAH were more likely to seek care in the emergency department (IRR: 2.30, 95%CI 1.71 to 3.11) and more likely to be hospitalized (IRR: 1.42, 95%CI 1.10 to 1.83).Meth-APAH represents a unique clinical phenotype of PAH, most common in the Western US. It accounts for a notable proportion of PAH in expert centers. Assessment for methamphetamine use is necessary in patients with PAH.

View details for DOI 10.1513/AnnalsATS.202007-774OC

View details for PubMedID 33064950