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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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
Copyright
© 2022 Elsevier Inc. All rights reserved.
