Cocaine is an established cardiovascular toxin, but the impact of cocaine use on clinical
outcomes in heart failure (HF) remains unknown. Although nonselective β-blocker use
in cocaine users with HF and reduced ejection fraction (HFrEF) appears to be safely
tolerated, selective β-blockers have not been evaluated. This study aimed to assess
whether cocaine use is associated with worse clinical outcomes in patients with HF
and evaluate the safety of β-blocker prescription upon discharge in cocaine users
with HFrEF. This was a single-center retrospective cohort study of patients with incident
HF hospitalization at a safety-net hospital. Primary outcomes included all-cause mortality
and readmissions, including HF. Cocaine users were compared with nonusers matched
by age, gender, and year of index admission. In cocaine users with HFrEF, outcomes
were compared according to β-blocker prescription at discharge. From 2001 to 2019,
738 cocaine users were identified and compared with 738 matched nonusers. Cocaine
use was associated with increased mortality (adjusted hazard ratio [HR] 1.21; 95%
confidence interval [CI] 1.00 to 1.48) and 90-day readmission (all-cause: adjusted
HR 1.49; 95% CI 1.20 to 1.85; HF: adjusted HR 1.49; 95% CI 1.10 to 2.01), persisting
at 1 year. In cocaine users who were prescribed metoprolol, carvedilol, or no β-blocker
at discharge, the rates of 1-year mortality and 30-day readmission were similar. In
conclusion, cocaine use is associated with increased all-cause mortality, HF readmission,
and all-cause readmission. Both nonselective and selective β-blocker may be safe in
managing patients with HFrEF and cocaine use.
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References
- The cardiovascular effects of cocaine.J Am Coll Cardiol. 2017; 70: 101-113
- Comparison of frequency of cardiovascular events and mortality in patients with heart failure using versus not using cocaine.Am J Cardiol. 2017; 119: 2030-2034
- 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee.J Am Coll Cardiol. 2021; 77: 772-810
- Death temporally related to the use of a beta adrenergic receptor antagonist in cocaine associated myocardial infarction.J Med Toxicol. 2007; 3: 169-172
- Letter: Propranolol in the treatment of cardiopressor effects of cocaine.N Engl J Med. 1976; 295: 448
- Propranolol promotes cocaine-induced spasm of porcine coronary artery.J Pharmacol Exp Ther. 1991; 257: 644-646
- Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade.Ann Intern Med. 1990; 112: 897-903
- Beta-blockers for chest pain associated with recent cocaine use.Arch Intern Med. 2010; 170: 874-879
- Clinical outcomes after treatment of cocaine-induced chest pain with beta-blockers: a systematic review and meta-analysis.Am J Med. 2019; 132: 505-509
- Effect of β-blocker therapy on hospital readmission and mortality in heart failure patients with concurrent cocaine use.J Cardiovasc Pharmacol Ther. 2018; 23: 518-523
- Clinical outcomes of Β-blocker therapy in cocaine-associated heart failure.Int J Cardiol. 2019; 277: 153-158
- Carvedilol among patients with heart failure with a cocaine-use disorder.JACC Heart Fail. 2019; 7: 771-778
- Beta blocker therapy in heart failure patients with active cocaine use: a systematic review.Cardiol Res Pract. 2020; 20201985379
- Improvement in clinical outcomes of patients with heart failure and active cocaine use after β-blocker therapy.Clin Cardiol. 2018; 41: 465-469
- Characteristics, trends, outcomes, and costs of stimulant-related acute heart failure hospitalizations in the United States.Int J Cardiol. 2021; 331: 158-163
- Cocaine, cardiomyopathy, and heart failure: a systematic review and meta-analysis.Sci Rep. 2020; 10: 19795
- Detection of subclinical myocardial dysfunction in cocaine addicts with feature tracking cardiovascular magnetic resonance.J Cardiovasc Magn Reson. 2020; 22: 70
Article info
Publication history
Published online: May 23, 2022
Received in revised form:
March 24,
2022
Received:
February 16,
2022
Footnotes
Dr. Hsue received funding provided by a National Institutes of Health grant, number NIH 2 K24 AI112393-06.
Identification
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© 2022 Elsevier Inc. All rights reserved.
