Rural Community Peer Partnerships for Improving Methamphetamine-Associated Heart Failure Screening and Engagement

NCT ID: NCT06461962

Last Updated: 2025-03-21

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 200 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-08-19
• Study Completion Date: 2029-06-30

Brief Summary

The goal of PEER-Heart is to implement and assess feasibility and preliminary effectiveness of a community peer-facilitated screening for methamphetamine-associated heart failure (MAHF) and linkage to evidence-based cardiology care for people who use methamphetamine in rural areas.

Detailed Description

Methamphetamine use has increased across the US in the midst of the opioid crisis, with rates of methamphetamine use in rural communities exceeding that in urban areas. Nationwide, methamphetamine-related hospitalizations increased 270% between 2007 and 2015, along with associated costs, lengths of stay and mortality. Methamphetamine-associated heart failure (MAHF) hospitalizations increased 12-fold over this time period; it is associated with worse symptoms (e.g. ejection fraction) and decreased adherence to guideline-directed medical therapy (GDMT) compared to heart failure not associated with methamphetamine use.

Despite the increased risk of heart failure and overdose for people who use methamphetamine in rural areas, interventions to improve engagement in cardiac screening and treatment services are underdeveloped. Multiple barriers decrease access to cardiac care in rural communities, including social determinants of health and health systems care delivery barriers. Stigma and distrust of healthcare providers, particularly in rural communities are known barriers to engaging in medical care-COVID-19 has only worsened this gap for people who use drugs.

Team-based cardiology care interventions can improve outcomes for people with heart failure, including one multi-disciplinary program that focused on methamphetamine-associated heart failure MAHF. However, these interventions have been tested in urban, higher resourced settings than those typical in rural communities. Interventions for screening and linkage to care for people who use drugs in rural areas with MAHF have not been developed.

The "experiential credentialing" afforded by peer recovery support specialists ("peers") offers a unique opportunity to reach, engage, and retain non-treatment-seeking people using drugs. The PEER-Heart study extends the role of peers as trusted community health workers in rural communities to improve MAHF screening and linkage to cardiology care. Increasing evidence reports feasibility, acceptability, and effectiveness of telehealth interventions in rural communities including cardiology services and retention in substance use treatment. Virtual visits for heart failure demonstrate promise in improving follow-up care though more study is warranted to demonstrate clinical outcomes effectiveness, and ensure these interventions do not worsen existing health inequities and the rural digital divide, particularly in minoritized groups.

The PEER-Heart study aims to demonstrate feasibility of screening of MAHF and linkage to evidence-based cardiology care for people who use methamphetamine in rural areas.

Conditions

Methamphetamine Use; Heart Failure

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: SCREENING
• Blinding Strategy: NONE

Study Groups

Peer-supported Treatment as Usual

Participants will receive a peer-supported referral to a local primary care provider who will create a plan to treat the participants heart failure.

Group Type: ACTIVE_COMPARATOR

Treatment as Usual

Intervention Type: OTHER

Peer-facilitated referral to a local primary care provider to follow-up their screening results.

Peer-Supported Telehealth Cardiology

Participants will receive a virtual consultation with a cardiovascular specialist, referral for a locally performed echocardiogram (ECG), and transitional care management facilitated by a remote nurse care manager and the peer to treat the participants heart failure.

Group Type: EXPERIMENTAL

Telehealth-Cardiology

Intervention Type: OTHER

Peer-facilitated virtual consultation with cardiovascular specialist, for follow-up of their screening results. Activities may include: referral for a locally performed testing including echocardiogram and additional blood work, and transitional care management facilitated by a remote nurse care manager and the peer

Referral for a locally performed testing including echocardiogram

Transitional care management facilitated by a remote nurse care manager and the peer

Interventions

Treatment as Usual

Peer-facilitated referral to a local primary care provider to follow-up their screening results.

Intervention Type: OTHER

Telehealth-Cardiology

Peer-facilitated virtual consultation with cardiovascular specialist, for follow-up of their screening results. Activities may include: referral for a locally performed testing including echocardiogram and additional blood work, and transitional care management facilitated by a remote nurse care manager and the peer

Referral for a locally performed testing including echocardiogram

Transitional care management facilitated by a remote nurse care manager and the peer

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Patient-defined regular use of methamphetamine in the last year
• Any methamphetamine use in the past 30 days
• Age 18 years or older
• No client-reported diagnosis of heart failure
• Able to communicate in English
• Screen positive for potential methamphetamine-associated heart failure (MAHF) defined as B type natriuretic peptide (BNP) ≥50 pg/ml, or QRS width ≥120ms, or presence of any clinical heart failure symptoms

Exclusion Criteria

• Self-reported engagement in medical care for heart failure in past 6 months.
• Actively taking medications for heart failure.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Washington

OTHER

Sponsor Role: collaborator

Bay Area First Step

UNKNOWN

Sponsor Role: collaborator

Oregon Health and Science University

OTHER

Sponsor Role: lead

Responsible Party

Brian L Chan

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Brian Chan, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Oregon Health and Science University

Locations

Oregon Health & Science University

Portland, Oregon, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Brian Chan, MD, MPH

Role: CONTACT

chanbri@ohsu.edu

503-494-2010

Kellie Pertl, MPH

Role: CONTACT

pertl@ohsu.edu

Facility Contacts

Brian Chan, MD, MPH

Role: primary

chanbri@ohsu.edu

503-494-2010

Other Identifiers

STUDY00026150

Identifier Type: -

Identifier Source: org_study_id