Abstract 4142436: The HeartPlus Clinic Project: Multidisciplinary Treatment for Patients with Stimulant-Associated Cardiomyopathy

Background: Stimulant-associated cardiomyopathy is an increasingly common cause of non-ischemic cardiomyopathy. Unfortunately, the last decade has seen dramatically higher rates of hospitalization for heart failure related to stimulant use. There are currently no Food and Drug Administration-approved medications for stimulant use disorder treatment (SUD). However, contingency management is a behavioral treatment that has been shown to be effective for SUD. In partnership with UC San Francisco, we developed a heart failure-addiction medicine co-management clinic (HeartPlus) to offer guideline-directed medical therapy in conjunction with contingency management to treat stimulant-associated cardiomyopathy over twelve weeks. The most common stimulant of abuse was methamphetamine. Methods: Our retrospective chart review assessed the feasibility of an Addiction Medicine and Heart Failure Cardiology co-management clinic at UC Davis. The clinic combined contingency management including point of care urine drug testing, as well as guideline-directed medical therapy for heart failure. We evaluated how many patients attended HeartPlus clinic at least once, how many completed the twelve-week program, and of those patients who completed the program, how many had improvement in self-reported symptoms as assessed by Kansas City Cardiomyopathy Questionaire (KCCQ-12) and left ventricular systolic function as assessed by echocardiogram. Results: A total of 39 patients were referred to HeartPlus Clinic. Of those referred, 25 patients attended the initial visit, and 7 patients successfully completed the 12-week program. Of the 7 patients who completed the program, 4 patients had improvement in left ventricular ejection fraction by at least ten percentage points. All 7 patients demonstrated improvement in KCCQ-12 scores by at least ten points (generally accepted as moderate improvement). Conclusions: The HeartPlus Clinic is a feasible treatment intervention for patients with stimulant-associated cardiomyopathy. For those patients who completed the program, they reported encouraging improvement in heart failure symptoms and four of seven demonstrated significant improvement in left ventricular systolic function. At an average cost of $74 per participant, this twelve-week multidisciplinary program is a promising area for future efforts to treat this growing population of disproportionately young patients.