Integrating Social Determinants in Cardiomyopathy Management: Addressing Non-Adherence and Substance Abuse

A 41-year-old male with a history of drug-induced dilated cardiomyopathy, ejection fraction 10-15%, untreated hepatitis C, ongoing substance misuse, and cirrhosis presented with worsening dyspnea, leading to acute decompensation and cardiogenic shock. Despite aggressive management including inotropic support, continuous renal replacement therapy, and mechanical ventilation, the patient's condition declined, resulting in a decision for palliative care. This case highlights the importance of addressing social determinants of health, including addiction management and patient education, to improve patient outcomes in similar multifaceted cases. Background: Non-ischemic cardiomyopathy often results from genetic factors or lifestyle choices such as substance abuse. The intersection of chronic illness, substance abuse, and poor medication adherence poses significant challenges in the management of cardiomyopathy, particularly when compounded by socio-economic factors and limited healthcare engagement. This report discusses the complexities of treating dilated cardiomyopathy within this context, stressing the necessity for an integrated approach that encompasses not only medical treatment, but also social and behavioral support systems. Objective: To discuss the severe consequences of non-adherence in the management of dilated cardiomyopathy exacerbated by substance abuse and to explore strategies for integrating social determinants of health into patient care to enhance outcomes.