Implementing Heart Plus: Design and Early Results of a Novel Comanagement Clinic for Patients With Stimulant-associated Cardiomyopathy

• Published in: Journal of cardiac failure 2024-07, Vol.30 (7), p.869-876
• Main Authors: Davis, Jonathan D., Bepo, Lurit, Suen, Leslie W., Mclaughlin, Megan M., Adamo, Meredith, Abbs, Elizabeth, Lemke, Grace, Azari, Soraya
• Format: Article
• Language: English
• Subjects: comanagement; contingency management; guideline-directed medical therapy for heart failure with reduced ejection fraction; heart failure; social determinants of health; stimulant use disorder; Stimulant-associated cardiomyopathy; systems of care
• ISSN: 1071-9164; 1532-8414; 1532-8414
• DOI: 10.1016/j.cardfail.2023.10.481

•Stimulant-associated cardiomyopathy (SA-CMP) is increasing in prevalence and is associated with worse outcomes compared with patients with cardiomyopathy from other causes.•We describe the methodology, design, and early results of a novel multidisciplinary comanagement clinic model with addiction medicine and cardiology providers using contingency management to engage patients with SA-CMP.•This 12-week intervention led to a 5-fold increase in outpatient care engagement with a concomitant 53% decrease in acute care use, and all participants reported a decrease in stimulant use. We describe the methodology, design, and early results of a novel multidisciplinary co management clinic model with Addiction Medicine and Cardiology providers using contingency management to engage patients with stimulant-associated cardiomyopathy (SA-CMP). Stimulant use, including methamphetamine and cocaine, is increasing in prevalence nationally and is associated with cardiovascular complications. People with SA-CMP have higher rates of mortality and acute care use (eg, emergency department visits, hospital admissions) and lower rates of outpatient care engagement than individuals with non–SA-CMP. This population also has disproportionately elevated rates of mental health and other medical comorbidities, challenges with social determinants of health, including housing and food insecurity, and representation from communities of color. This multidisciplinary comanagement care delivery model, called Heart Plus, was developed and funded as a quality improvement project. It led to a 5-fold increase in outpatient care engagement with a concomitant 53% decrease in acute care use. All participants reported a decrease in stimulant use. With increased clinical stability, patients were able to better engage with outpatient resources for social determinants of health, such as case management, social work, and housing and food service programs. Patients were also empowered to take control over their health while knowing that health care providers cared about their well-being.