Abstract
Methamphetamine (meth)-associated cardiomyopathy and meth use in patients with heart failure (HF) continues to increase in prevalence and is associated with greater health care resource utilization and very poor outcomes. There is a critical need to examine the direct incorporation of meth use disorder (MUD) treatment into the simultaneous management of HF. Addressing one condition without the other contributes to the vicious cycle of repeated hospitalizations, increasing and inefficient health care resource utilization, and poor patient outcomes.
The overarching objective of the current proposal is to demonstrate the feasibility and preliminary value of a HF clinic for meth users that integrates MUD treatment. This will be a prospective, open-label, single-arm study to evaluate the feasibility and preliminary efficacy of a multidisciplinary HF clinic which integrates pragmatic MUD assessment and treatment along with standard-of-care guideline-directed HF management. A cardiologist will oversee HF management, while a psychiatric clinical pharmacist will lead the MUD management. MUD management will consist of behavioral counselling and contingency management with or without adjunctive pharmacotherapy. Fifty patients identified with HF and concomitant active meth use will be enrolled consecutively and followed in the clinic for 6 months. Clinical endpoints include abstinence from meth, metrics for HF guideline-directed medical therapy optimization, and changes in patient-centered outcomes (meth craving scale scores and HF status captured using the KCCQ-12). Cost of care delivery will be enumerated and used to estimate a potential range of cost savings. Endpoints will be assessed at baseline and compared over the 6 months of follow up. The study will provide preliminary data to pursue larger extramural grants to continue the clinic model, evaluate more broadly the clinical and economic impact, and improve the quality of care of the surrounding community served by LA DHS.