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Comparison of Frequency of Cardiovascular Events and Mortality in Patients With Heart Failure Using Versus Not Using
Peter Nguyen1, Hassan Kamran2, Saifullah Nasir2
1Department of Internal Medicine and Cardiology, Baylor College of Medicine, Houston, Texas; Department of Internal Medicine and Cardiology, Winters Center for Heart Failure Research, Houston, Texas.
Insights
Beta-blocker medications are safe for patients with systolic heart failure (HF) and a history of cocaine use. These treatments did not increase adverse cardiovascular events or mortality compared to patients without cocaine use.
Area of Science:
- Cardiology
- Pharmacology
- Toxicology
Background:
- Systolic heart failure (HF) treatment typically includes beta-blockers, improving patient outcomes.
- Limited data exist on beta-blocker safety in HF patients with a history of cocaine use due to perceived risks.
- Cocaine use is associated with cardiovascular complications, raising concerns about concurrent beta-blocker therapy.
Purpose of the Study:
- To evaluate the safety of beta-blocker treatment in systolic HF patients with a history of cocaine use.
- To compare outcomes between HF patients with and without a history of cocaine use receiving beta-blockers.
- To assess differences in outcomes between cardioselective and noncardioselective beta-blockers in HF patients with cocaine use.
Main Methods:
- Retrospective comparison of 90 systolic HF patients with cocaine use against 177 systolic HF patients without cocaine use.
- Outcomes assessed included HF readmissions, major adverse cardiovascular events (MACE), and all-cause mortality.
- Multivariable Cox proportional hazard models were used, adjusting for key demographic and clinical factors.
Main Results:
- Beta-blocker treatment in HF patients with cocaine use showed no significant differences in HF readmissions (HR 0.66), MACE (HR 0.58), or death (HR 0.96) compared to those without cocaine use.
- Combined outcomes were also not significantly different (HR 0.76) between the groups.
- Among HF patients with cocaine use, mortality rates did not significantly differ between noncardioselective and cardioselective beta-blocker use (HR 1.50).
Conclusions:
- Beta-blocker therapy is safe in systolic heart failure patients with a history of cocaine use.
- The presence of cocaine use history does not appear to be associated with adverse outcomes when treated with beta-blockers.
- Cardioselective and noncardioselective beta-blockers demonstrated similar safety profiles in this patient population.
Abstract:
Beta-blocker treatment improves left ventricular function, morbidity, and survival in patients with systolic heart failure (HF). However, there are limited data addressing the safety and efficacy of β blockers in the setting of cocaine use as there is a perceived risk of adverse outcomes. Our aim was to determine if beta-blocker treatment was safe in HF patients with a history of cocaine use compared with HF patients without history of cocaine use. We also examined whether effects differed between cardioselective versus noncardioselective β blockers. Ninety systolic HF patients with cocaine use were compared with 177 patients with nonischemic, systolic HF, and no cocaine use. Outcomes were HF readmissions, major adverse cardiovascular events, and death using multivariable Cox proportional hazard models adjusted for age, black race, hypertension, diabetes, coronary artery disease, renal insufficiency, and angiotensin-converting enzyme inhibitors. Beta-blocker treatment in systolic HF patients with cocaine use did not have significant differences in HF readmissions (hazard ratio [HR] 0.66, 95% CI 0.31 to 0.1.38), major adverse cardiovascular events (HR 0.58, 95% CI 0.27 to 1.09), death (HR 0.96, 95% CI 0.39 to 2.34), or all combined outcomes (HR 0.76, 95% CI 0.39 to 1.47) compared with beta-blocker treatment in HF patients without cocaine use. Within HF patients with cocaine use, mortality rates (HR 1.50, 95% CI 0.28 to 8.23) were not significantly different between patients treated with noncardioselective versus cardioselective β blockers. In conclusion, beta-blocker treatment in systolic HF patients with cocaine use was not associated with adverse outcomes.
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