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Weathering the perfect storm: management of heart failure in patients with substance use disorders
  1. Jacqueline DesJardin1,
  2. Sarah Leyde2,
  3. Jonathan Davis1,3
  1. 1 Cardiology, University of California San Francisco, San Francisco, California, USA
  2. 2 Division of General Internal Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA
  3. 3 Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
  1. Correspondence to Dr Jonathan Davis, Cardiology, University of California San Francisco, San Francisco, CA 94110, USA; jonathan.davis{at}

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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.

SUDs 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.

Patient-centred care

Providing 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 motivational …

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  • Contributors All three authors contributed to the development, writing and editing of this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.