Journal Article

Weathering the perfect storm: management of heart failure in patients with substance use disorders

DesJardin, Jacqueline, Leyde, Sarah, Davis, Jonathan

2021

Overview

A recent clinical trial of people with near-daily methamphetamine use achieved >75% study-drug adherence via financial incentives and close follow-up.5 Bubble packs are useful, as is preferentially choosing once per day dosing options (eg, metoprolol succinate over carvedilol). A recently established inpatient consultation addiction care team at our hospital provides services such as motivational interviewing, discussion of safer use strategies, behavioural and pharmacological SUD treatment, and linkage to ongoing care in the community.6 To address social determinants of health, we established a multidisciplinary team (cardiology, primary care, palliative care, addiction medicine, social work, case management and street medicine), which meets monthly to discuss patients with HF, SUDs and frequent admissions. Directly observed therapy and reward-based incentives have been shown to be effective in chronic disease management in patients with SUDs and infectious diseases, but these strategies remain underexplored in HF.7 We developed a novel two times-per-week cardiology–addiction comanagement clinic for patients with co-occurring HF and stimulant use disorder which incorporates contingency management (figure 1). A systematic review of community-based interventions to improve oral chronic disease medication regimen adherence among individuals with substance use disorder.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD
• Subject: Addictions / Cardiology / Cardiology in focus / Chronic illnesses / Clinics / Drug use / Heart failure / Hospitals / Medicine / Methamphetamine / Mortality / Multidisciplinary teams / Narcotics / Patient compliance / Patient-centered care / Primary care / Substance abuse treatment / Substance use disorder