A Mixed-methods Evaluation of an Addiction/Cardiology Pilot Clinic With Contingency Management for Patients With Stimulant-associated Cardiomyopathy

Abstract

ObjectivesContingency management (CM) is one of the most effective treatments for stimulant use disorder but has not been leveraged for people with stimulant-associated cardiomyopathy (SA-CMP), a chronic health condition with significant morbidity and mortality. We aimed to determine the feasibility and acceptability of a multidisciplinary addiction/cardiology clinic with CM for patients with SA-CMP and to explore barriers and facilitators to engagement and recovery.MethodsWe recruited patients with a hospitalization in the past 6 months, heart failure with reduced ejection fraction (<40%) and stimulant use disorder to participate in Heart Plus, a 12-week addiction/cardiology clinic with CM in an urban, safety-net, hospital-based cardiology clinic, which took place March 2021 through June 2021. Contingency management entailed gift card rewards for attendance and negative point-of-care urine drug screens. Our mixed-methods study used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We obtained data from the medical record, staff surveys, and qualitative interviews with participants.ResultsThirty-eight patients were referred, 17 scheduled an appointment, and 12 attended the intake appointment and enrolled in the study. Mean treatment duration was 8 of 12 weeks. Of the 9 participants who attended more than one visit, the median attendance was 82% of available visits for in-person visits and 83% for telephone visits, and all patients reported decreased stimulant use.ConclusionsDelivering CM through a multidisciplinary addiction/cardiology clinic for patients with SA-CMP was feasible and engaged patients in care. Further research is needed to assess whether this program is associated with improved heart failure outcomes.

Presentation and Outcomes of Adults With Overdose-Related Out-of-Hospital Cardiac Arrest

“…While we did not have access to information related to long-term substance use prior to OHCA, previous studies have found an association between long-term stimulant use and cardiovascular pathology, including atherosclerosis and cardiomyopathy . The extent to which this underlying pathology further challenges resuscitation and outcomes in the setting of stimulant-only OHCA is unknown but may have implications for the timing and scope of preventive measures in this population …”

“…30 The extent to which this underlying pathology further challenges resuscitation and outcomes in the setting of stimulant-only OHCA is unknown but may have implications for the timing and scope of preventive measures in this population. 31,32 We observed poorer outcomes among patients with OHCA with combined opioid and stimulant use. Despite similar EMS response and treatment profiles to other OD groups, this combined group was less likely to be alive at the end of EMS care and had lower survival to hospital discharge.…”

“… 30 The extent to which this underlying pathology further challenges resuscitation and outcomes in the setting of stimulant-only OHCA is unknown but may have implications for the timing and scope of preventive measures in this population. 31 , 32 …”

An Attendance-based Contingency Management Pilot Program for Veterans Experiencing Homelessness With Stimulant-associated Cardiomyopathy in Primary Care

“…We are writing in response to the article “A mixed methods evaluation of an addiction/cardiology pilot clinic with contingency management for patients with stimulant-associated cardiomyopathy” published by Leyde et al 1 in December 2022. We want to share a similar contingency management (CM) feasibility pilot conducted among a vulnerable veteran patient population with stimulant-associated cardiomyopathy (SA-CMP).…”

Too much heterogeneity: envisioning a new approach to methamphetamine associated heart failure

“…A multidisciplinary team designed to meet this population’s unique needs and deliver non-stigmatising, patient centred care is mandatory. This model has been shown to be highly effective in increasing engagement and clinic attendance while simultaneously reducing stimulant use and acute care utilisation 9. Meaningful progress necessitates that healthcare systems financially commit to novel care delivery approaches that support and encourage patient engagement and reduce methamphetamine use.…”