# Rural community peer partnerships for improving methamphetamine -associated heart failure screening and engagement in cardiology care (PEER-Heart): Study protocol

## TL;DR

This study tests a peer-led screening and telecardiology approach to improve heart failure detection and care for methamphetamine users in rural areas.

## Contribution

The study introduces a novel peer-assisted model combining point-of-care screening and telecardiology for methamphetamine-associated heart failure in rural communities.

## Key findings

- Peer-assisted screening with BNP testing and telecardiology may improve linkage to heart failure treatment.
- The study will assess the feasibility and acceptability of integrating peer support into cardiovascular care for high-risk populations.
- Implementation barriers and facilitators will be analyzed using qualitative methods and the RE-AIM framework.

## Abstract

Methamphetamine-associated heart failure (MAHF) is increasingly prevalent in rural communities, where limited specialty care and barriers to healthcare engagement hinder early diagnosis and treatment. Peer-led screening with brain natriuretic peptide (BNP) testing, supported by telemedicine, may enhance early detection and linkage to cardiology care.

PEER-Heart is a hybrid type 1 effectiveness-implementation trial to evaluate the feasibility, acceptability, and effectiveness of a peer-assisted point-of-care screening protocol and telecardiology intervention for MAHF in rural Oregon.

We will recruit 122 adults reporting methamphetamine use within the past 30 days from two rural Oregon counties. Individuals will be screened for MAHF by peers using a symptom questionnaire, brain natriuretic peptide (BNP) testing, and a mobile electrocardiogram. Individuals who screen positive will be randomized to a peer-facilitated telecardiology intervention or enhanced usual care (EUC). Primary outcome is linkage to heart failure treatment at 2 months. Secondary outcomes include changes in symptom severity, knowledge, and engagement in guideline-directed medical therapy. Implementation barriers and facilitators will be assessed through interviews and focus groups using thematic analysis and the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. We hypothesize that peer-assisted telecardiology will result in higher linkage to care. The study will assess the feasibility and acceptability of peer-delivered cardiovascular screening and telecardiology in high-risk populations.

PEER-Heart addresses a critical gap in early detection and management of heart failure for people who use methamphetamine in rural settings. Findings will inform efforts to scale peer-integrated telemedicine programs for underserved populations with complex needs.

•Methamphetamine use is associated with heart failure.•Peer support and telecardiology improve early detection and care linkage.•Trial tests feasibility, acceptability, and effectiveness of peer assisted approach.•Implementation outcomes assessed using qualitative and mixed methods.•Model addresses stigma and structural barriers to reduce heart disease disparities.

Methamphetamine use is associated with heart failure.

Peer support and telecardiology improve early detection and care linkage.

Trial tests feasibility, acceptability, and effectiveness of peer assisted approach.

Implementation outcomes assessed using qualitative and mixed methods.

Model addresses stigma and structural barriers to reduce heart disease disparities.