Implementing Heart Plus: Design and Early Results of a Novel Comanagement Clinic for Patients With Stimulant-associated Cardiomyopathy.
Level 4 - case-series / case-control
Uncontrolled quality improvement pre-post program evaluation
PubMed 37984791 · doi:10.1016/j.cardfail.2023.10.481
What was done
The authors described the implementation and early results of "Heart Plus," a quality improvement multidisciplinary comanagement clinic integrating Addiction Medicine and Cardiology providers. The clinic utilized contingency management to engage patients with stimulant-associated cardiomyopathy (associated with methamphetamine or cocaine use) and connected them to services addressing social determinants of health.
What was found
The program led to a reported 5-fold increase in outpatient care engagement and a concomitant 53% decrease in acute care utilization (such as emergency department visits and hospital admissions). All participants reportedly reduced stimulant use and engaged better with social work, case management, and housing or food programs. The abstract did not report absolute numbers, baseline rates, sample size, or measures of statistical variance.
Why it matters
Stimulant-associated cardiomyopathy is associated with high acute care use and poor outpatient follow-up. This model suggests that integrating addiction medicine and cardiology with contingency management can improve care continuity and reduce acute hospital utilization in this complex population.
Limits
The study is an uncontrolled quality improvement evaluation with an unspecified sample size (n is not reported in the abstract). It lacks a separate control group, leaving findings susceptible to confounding and regression to the mean. Reductions in stimulant use relied on self-report rather than objective toxicology confirmation in the abstract, and hard clinical cardiovascular endpoints were not reported.
Cited by
- supports Stimulant use, particularly cocaine, is associated with a high incidence of heart failure and premature cardiac death.