313. Stimulant-Associated Cardiomyopathy with Dr. Soraya Azari and Dr. Jonathan Davis

Stimulant use disorder significantly contributes to the rising incidence of heart failure, with methamphetamine-associated hospitalizations increasing from 1.2% to 8% in California over a decade. Pathophysiological mechanisms involve persistent adrenergic stimulation, direct myocardial toxicity, and microvascular dysfunction. Effective management requires Guideline-Directed Medical Therapy (GDMT) alongside the cessation of stimulant use, which often correlates with improved ejection fraction and reverse remodeling. Innovative care models, such as the Heart Plus Clinic, demonstrate that co-locating cardiology and addiction medicine services—anchored by contingency management—improves patient engagement, reduces acute care utilization, and facilitates access to social support. Clinicians should adopt non-judgmental screening techniques, prioritize harm reduction, and avoid diagnostic bias when evaluating patients with heart failure who use stimulants, ensuring that underlying ischemic or other reversible etiologies are not overlooked during the diagnostic process.