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We report the ethnic and geographical distribution of patients undergoing extracorporeal membrane oxygenation (ECMO) at our institution in Honolulu, Hawaii. Some of the unique aspects of utilizing ECMO in the state of Hawaii include the complex geography of the Hawaiian islands separated by up to 400 km of ocean, as well as the transportation of patients from Hawaii to centers on the mainland that offer advanced cardiac therapies, the nearest which are 4000 km away. Patients who underwent venovenous (VV) and venoarterial (VA) ECMO cannulation from 2015-2022 were included in the analysis. Patient characteristics prior to cannulation and survival outcomes were analyzed. Ethnicity was compared to 2021 census data in the state of Hawaii. A total of 46 patients who underwent ECMO (VV =21 and VA = 25) were analyzed. The majority of ECMO patients were of Asian descent (50%), and 9% were of Native Hawai'ian descent. This reflects the ethnic diversity of Hawaii when compared to 2021 census data (37% Asian and 11% Native Hawai'ian). The most common indication for VA ECMO was cardiogenic shock due to advanced heart failure (26%) and for VV ECMO was COVID ARDS (22%). The majority of patients were from the island of Oahu (76%), and the remainder (26%) were from the other islands combined. In addition, 11% were transported to the mainland for advanced therapies on ECMO support. Survival to hospital discharge was 57% (48% for VA ECMO and 67% for VV ECMO). The patient characteristics of the ECMO program in our institution demonstrate the unique challenges and benefits of maintaining an ECMO program in Hawaii. Some potential solutions to mitigate these challenges include developing outreach programs for cardiac and critical care providers from the outer islands regarding the ECMO capabilities of our institution, consideration for mobile ECMO air units to cannulate patients directly in the outer islands, and the ability to offer end-stage therapies for cardiac and pulmonary failure on island. [ABSTRACT FROM AUTHOR]

Advanced Heart Failure and Transplant Cardiology (AHFTC) teams are crucial in the management of patients in shock requiring extracorporeal membrane oxygenation (ECMO). We assess the impact of direct rather than consultative involvement by an AHFTC team in the selection and management of ECMO patients at our institution in Honolulu, Hawaii. A retrospective analysis of 46 patients on venovenous (VV) and venoarterial (VA) ECMO between 2015 - 2022 was conducted. Patients were classified based on the role of the AHFTC team. The evaluated outcomes were survival after ECMO decannulation and at hospital discharge. Out of 46 ECMO patients, 25 patients were managed by intensivist led teams with the AHFTC team serving as ECMO consultants. 21 patients were managed in a model where AHFTC physicians also served as primary ECMO attendings, with a direct role in patient selection. A comparison of RESP and SAVE risk scores was not statistically significant among the two cohorts with P-values of 0.57 and 0.28 respectively. For the overall ECMO cohort (VV and VA), 76% of patients survived after decannulation and 71% of patients survived at hospital discharge with AHFTC primary involvement, while 71% of patients survived after decannulation and 44% of patient survived at hospital discharge without AHFTC primary involvement. In the VA ECMO cohort, 73% of patients survived at hospital discharge with AHFTC primary involvement and 29% without AHFTC primary involvement (P-value = 0.04). This study suggests that patients in cardiogenic shock requiring VA ECMO have improved survival at time of hospital discharge when the AHFTC team plays a more direct role in the selection and management of patients. Further studies are needed to validate this impact. [ABSTRACT FROM AUTHOR]

Methamphetamine (meth) use is now the second most used illicit substance worldwide. Methamphetamine-associated cardiomyopathy/heart failure (MethHF) is an increasingly recognized disease entity. Previous literature has showed that racial and ethnic minority populations are at higher risk for meth use. We set out to characterize the degree of burden of MethHF through the lens of ethnicity at a major metropolitan, tertiary hospital hospital system in Hawaii. A retrospective chart review from 2011 to 2021 including all adult patients (≥18 years old) with positive meth urine drug screen or with prior diagnosis of meth use with and without a diagnosis of cardiomyopathy in the electronic medical record were included for analysis. They were compared to patients with heart failure from any cause as defined by a serum BNP >200, serum NT proBNP >200, or a positive history of cardiomyopathy as defined by ICD codes in the electronic medical record. The socio-demographics of patients presenting with MethHF are included in Table 1. 46,849 patients were included for analysis. MethHF was seen most commonly in the Native Hawaiian, Caucasian, and Filipino population with the three groups making up for 65% of the total MethHF burden. The prevalence of meth use was highest in the Caucasian population, however MethHF was seen more commonly in the Native Hawaiian population. The prevalence of MethHF in the Native Hawaiian population is more striking when compared to 2020 census data showing that only 5% of the island's population identify as such. Our results suggest that the burden of meth use and MethHF at our institution is higher in minority populations. This study suggests that greater awareness of psychosocial factors in MethHF patients is needed to better prevent and treat this burgeoning disease. [ABSTRACT FROM AUTHOR]

Methamphetamine (meth) is becoming an increasingly recognized etiology of heart failure (HF). There remains paucity of data regarding the echocardiographic parameters in patients with methamphetamine cardiomyopathy/heart failure (MethHF). We set out to determine the echocardiographic parameters of MethHF at a major, tertiary clinical centre in Hawaii. A retrospective chart review from 2011 to 2022 was performed. HF patients were divided into two groups: MethHF and non MethHF based on their history of meth use. Patients with a diagnosis of HF were defined by serum BNP > 200, serum NT proBNP >400, or a prior positive history of cardiomyopathy as defined by ICD codes. Patients with positive meth use were defined by a positive urine drug screen or prior diagnosis of meth use as defined by ICD codes. HF patients were divided into three groups based on their ejection fraction (EF) on echocardiography: HF with reduced ejection fraction (HFrEF): EF ≤40%; HF with mildly reduced ejection fraction (HFmrEF): EF 41-49%; HF with preserved ejection fraction (HFpEF): EF ≥50%. In our study, 2552 patients were found to have MethHF, 22317 patients were found to have non-MethHF. A significantly higher proportion of patients in the MethHF subgroup were found to have HFrEF (47.1% vs 27.8%, p<0.001). Significantly more patients with non-MethHF were found to have HFpEF (37.4 % vs 57.7%, p<0.001). There was no difference in the percentage of patients with HFmrEF between the two groups (15.6% vs 14.5%, p=0.158). We also found that patients in the MethHF subgroup had higher mean left ventricle diastolic dimension (5.32 vs 4.65 cm, p<0.001) and mean right ventricular systolic pressure (40.98 vs 38.61 mmHg, p=0.038). MethHF patients had lower TAPSE compared to non MethHF patients (1.82 cm vs 1.9 cm, p=0.007). Our study demonstrates that meth users have larger cardiac dimensions and more severe left ventricular dysfunction than those with heart failure and no history of meth use. We demonstrate that meth patients have an increased RVSP and lower TAPSE which are both statistically significant, but may not be clinically significant. Further insight into the long term consequence of meth use in the setting of heart failure is needed to determine if these difference in echo parameters pertains to worse clinical outcomes. [ABSTRACT FROM AUTHOR]

Variation in outcomes by race, ethnicity, and socioeconomics in adults with heart failure (HF) has been previously observed. We evaluated the association of these factors with HF outcome as assessed by frequency of emergency department (ED) visits over the last 2 and 10 years in a contemporary HF cohort in Hawaii. A retrospective chart review from 2011 to 2021 was performed to identify all adult patients (≥18 years old) with HF from any cause as defined by a serum BNP >200, NT proBNP >200, or a positive history of HF as defined by ICD codes. Ethnicities were self-reported at time of intake at the ED. Meth use was defined as a positive urine toxicology screen or by ICD codes. MethHF was defined as HF in a patient with meth use. A regression model was made to evaluate the relative risk of patients with HF to present to the ED over the last 2 years and 10 years adjusted for age, gender, ethnicity, presence of methamphetamine associated cardiomyopathy (MethHF). Homelessness was analyzed as a secondary subgroup. 46,849 patients were included for analysis. Over the last 10 years (Table 1) Filipino and Japanese patients had a lower risk for presentation to the ED: 17% and 34% respectively. Pacific Islanders, patients with MethHF, and homelessness had a higher risk for presentation to the ED: 44%, 152%, and 160% respectively. Over the last 2 years (Table 2) Japanese patients had a 34% lower risk for presentation to the ED. Black and Pacific Islander patients, those with MethHF, and homelessness had a higher risk for presentation to the ED, 66%, 52%, 28%, and 249% respectively. The relative risk of presentation to the ED in the last 10 years and 2 years differs greatly by ethnicity and presence of MethHF regardless of gender and age. Homelessness had the highest relative risk of ED presentation. Future research is needed to identify explanatory mechanisms underlying racial, ethnic, socioeconomic variations to target potential interventions. [ABSTRACT FROM AUTHOR]

Methamphetamine-associated heart failure (MethHF) is an increasingly recognized disease entity in the context of a rising methamphetamine (meth) epidemic in the United States. There remains paucity of data regarding the epidemiology and clinical characteristics of people with MethHF. We set out to determine the clinical characteristics of MethHF at a major, tertiary hospital system in Hawaii. A retrospective chart review from 2011 to 2021 including all adult patients (≥18 years old) with positive meth urine drug screen or with prior diagnosis of meth use with and without a diagnosis of cardiomyopathy as defined by a serum BNP >200, serum NT proBNP >200, or a positive history of cardiomyopathy as defined by ICD codes in the electronic medical record were included for analysis. The demographics and outcome data are included in Table 1. 46,891 patients were assessed. There were 16,493 patients identified with meth use. One out of 6 (16.2%) of this patient population had heart failure. Patients in the MethHF subgroup were predominantly male and were two decades younger compared to the non-MethHF population. There was a similar burden of uninsured patients in both populations. A larger portion of MethHF patients were native Hawaiian and homeless. MethHF patients were more frequent visitors of the emergency department compared to the non-MethHF population. Strikingly, the onset of cardiomyopathy in patients with meth use appears to occur at a much younger age than the non-meth cardiomyopathy population. In addition, the MethHF population were more frequent utilizers of the emergency department compared to non-meth cardiomyopathy patients. Given the increasing prevalence of MethHF we advocate for targeted treatment plans focused on both prevention and management of heart failure in affected populations. Understanding who those are that are most affected serves as a pilot study to future intervention. [ABSTRACT FROM AUTHOR]