• Heart Failure
• Cardiomyopathies
• Cardiomyopathy, Dilated
• Epidemiology
• Outcome Assessment, Health Care

Methamphetamine use is rising nationally,1 2 and with it the incidence of its many cardiopulmonary complications.3 Patients with cardiomyopathy and heart failure due to methamphetamine (MethHF) use are at an increased risk of acute care utilisation (eg, emergency department, inpatient hospitalisation), morbidity and mortality.4 In California, methamphetamine associated admissions increased from 1.2% of all hospitalisations in 2008 to 8% in 2018, a 600% increase.5 Methamphetamine use was an independent predictor of heart failure readmission (OR 3.62, 95% CI 1.40 to 9.38) at our safety-net hospital in San Francisco.6

Barriers to effective treatment of cardiomyopathy due to stimulant use are many: the exact pathophysiology, dose–response and incidence are unknown, continued drug use both drives further disease progression and impedes medical care engagement, and there are limited effective treatment options to reduce use. Co-occurring mental health and other substance use issues and under-resourced socioeconomic and social support (eg, unstable housing, food insecurity, etc) all obstruct outpatient care delivery. These social determinants of health disproportionately affect this population, playing a large role in the elevated risks of hospitalisation for heart failure, morbidity and mortality. Also, the stigma associated with stimulant use too often negatively biases providers, further estranging the care alliance. Rates of acute care utilisation (urgent care, emergency department) are disproportionately high while …