Weathering The Perfect Storm: Management Of Heart Failure In Patients With Substance Use Disorders

Co-occurring substance use disorders (SUDs) and heart failure (HF) create a perfect storm: the drug drives cardiac pathophysiology, while complex psychosocial factors interfere with treatment efforts. Patients with SUDs and HF are less likely to engage in care due to chaotic use patterns, poverty, co-occurring mental illness, mistrust in the healthcare system and decreased social support. The stigma of drug use can also negatively bias providers, further complicating the care alliance.\n\nSUDs complicate at least 15% of HF hospitalisations.1 At our safety-net hospital in San Francisco, methamphetamine use is an independent predictor of HF readmission (OR 3.62, 95% CI 1.40 to 9.38).2 High rates of co-occurring HF and SUDs contributed to our hospital having some of the worst HF readmission rates in California. Using strategies discussed in this article, we decreased our HF readmission rate by 30% in 2019. Along the way, we learnt valuable lessons about managing co-occurring HF and SUDs, most importantly that successful treatment demands multidisciplinary attention to both disorders.\n\nProviding non-judgemental, patient-centred care is key to developing a therapeutic alliance. Providers should avoid stigmatising language and instead use person-first, medically accurate terminology (ie, ‘person with methamphetamine use disorder’ instead of ‘meth addict’).3 Respecting the patient is key. Arguing, shaming and providing unsolicited advice should be avoided. Instead, we use …