*Purpose: FDA-approved prescribed stimulants are purported to increase risk of cardiovascular (CV) adverse events, particularly arrhythmias and sudden cardiac death. Debate exists regarding the safety of stimulants in the CV population, with even more uncertainty in heart transplant (HT) recipients. This study aims to characterize the safety of stimulant use following HT.

*Methods: This single center retrospective cohort study included adult HT recipients transplanted from January 1^st 1990 to March 1^st 2021 with post-HT exposure to stimulant therapy in either the inpatient or outpatient setting. Patients were excluded if expired prior to discharge from index admission, HIV seropositive, or multi-organ transplant recipients. Exposure was defined as having been prescribed a stimulant medication, either amphetamine or non-amphetamine based. The primary outcome was incidences of arrhythmia, both ventricular and supraventricular, or major adverse cardiovascular events (MACE). Secondary outcomes included incidences of rejection or graft loss. Outcomes were assessed for at least 6 months following stimulant initiation and compared to post-HT incidence rates observed prior to stimulant initiation. Data was analyzed by Fisher’s exact test and a two-sided p value of less than 0.05 was considered significant.

*Results: Twenty-seven HT recipients were included for analysis, with a majority of white, male (66.7%) patients. HT indications included non-ischemic cardiomyopathy (59.3%), ischemic cardiomyopathy (29.6%), and other (11.1%). A minority of patients had diagnoses of attention deficit disorders (29.6%), with the majority diagnosed with other mood disorders (77.8%). The mean age (SD) at stimulant initiation post-HT was 50.6 years (±14.6), and the mean time (SD) from HT to stimulant initiation or resumption was 6.1 years (±6.7). Following HT, 92.6% received an amphetamine-based agent, while 14.8% received a non-amphetamine based agent. No significant differences in primary or secondary outcomes were observed (Table 1).

*Conclusions: Prescribed stimulant use in HT recipients was not associated with arrhythmia, MACE, rejection, or graft loss. Given numerous confounders and small sample size, further investigation is warranted to determine safety in HT recipients.

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