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

Jonathan D Davis; Lurit Bepo; Leslie W Suen; Megan M Mclaughlin; Meredith Adamo; Elizabeth Abbs; Grace Lemke; Soraya Azari

doi:10.1016/j.cardfail.2023.10.481

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

J Card Fail. 2023 Nov 19:S1071-9164(23)00871-0. doi: 10.1016/j.cardfail.2023.10.481. Online ahead of print.

Authors

Jonathan D Davis¹, Lurit Bepo², Leslie W Suen³, Megan M Mclaughlin⁴, Meredith Adamo⁵, Elizabeth Abbs⁵, Grace Lemke⁶, Soraya Azari³

Affiliations

¹ Division of Cardiology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California. Electronic address: Jonathan.davis@ucsf.edu.
² Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California; National Clinician Scholars Program, University of California, San Francisco.
³ Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California.
⁴ Division of Cardiology, University of California, San Francisco, San Francisco, California.
⁵ San Francisco Department of Public Health, San Francisco, California.
⁶ San Francisco Department of Public Health, San Francisco, California; AmeriCorps, National Health Corps San Francisco, California.

PMID: 37984791
DOI: 10.1016/j.cardfail.2023.10.481

Abstract

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.

Keywords: Stimulant-associated cardiomyopathy; comanagement; contingency management; guideline-directed medical therapy for heart failure with reduced ejection fraction; heart failure; social determinants of health; stimulant use disorder; systems of care.