Methamphetamine-Associated Heart Failure (MethHF) is a serious complication of methamphetamine use (MU) that is associated with more hospitalizations and greater morbidity and mortality than non-methamphetamine related heart failure (non-MethHF). Currently, regular adherence to guideline-directed medical therapy (GDMT) for heart failure can lead to the reversal of heart failure, even when complete abstinence of methamphetamine is not maintained. However, adhering to GDMT is challenging for patients with MethHF since they experience comorbidities including housing and financial instability, co-occurring mental illness, and reduced social support among others. This quality improvement project utilized the Model for Improvement framework to evaluate patient perceptions of barriers to medication adherence in those with MethHF at a heart failure clinic in the Portland metro area.