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

Background: 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. Aim: 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. Methods: 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. Conclusion: 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.