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Effect of β-blocker Therapy on Hospital Readmission and Mortality in Heart Failure Patients With Concurrent Cocaine
Obiora Egbuche1, Ifunanya Ekechukwu2, Valery Effoe1
11 Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA.
Insights
Continuous beta-blocker therapy (BBT) significantly reduced 30-day readmissions for heart failure patients with reduced ejection fraction (HFrEF) who use cocaine. However, BBT did not impact 1-year mortality in this population.
Area of Science:
- Cardiology
- Pharmacology
- Toxicology
Background:
- Heart failure with reduced ejection fraction (HFrEF) is a major cardiovascular condition.
- Beta-blocker therapy (BBT) is a cornerstone treatment for HFrEF, reducing symptoms, hospitalizations, and mortality.
- The safety and efficacy of BBT in patients with concurrent cocaine use are not well-established.
Purpose of the Study:
- To evaluate the impact of continuous BBT on hospital readmission and mortality rates.
- To investigate outcomes in patients with HFrEF who actively use cocaine.
Main Methods:
- Retrospective study of HFrEF patients (2011-2014) identified via ICD-9 codes.
- Inclusion criteria: age ≥18, positive urine cocaine test at admission.
- Follow-up for 1 year; multivariate logistic regression used to analyze readmission rates.
Main Results:
- Beta-blocker therapy (BBT) was associated with significantly lower 30-day heart failure-related readmissions (20% vs. 41%, OR=0.17).
- BBT also reduced 30-day all-cause readmissions (25% vs. 46%, OR=0.19).
- No significant difference in 1-year mortality was observed between BBT and no BBT groups.
Conclusions:
- Continuous BBT effectively reduces short-term readmissions in HFrEF patients with active cocaine use.
- BBT does not appear to influence 1-year mortality in this specific patient cohort.
- Further research is warranted to fully understand long-term outcomes and optimize management.
Background:
β-Blockers are first-line agents for reduction in symptoms, hospitalization, and mortality in patients with heart failure having reduced ejection fraction (HFrEF). However, the safety and efficacy of continuous β-blocker therapy (BBT) in patients who actively use cocaine remain controversial, and available literature is limited. We aimed to evaluate the effect of BBT on hospital readmission and mortality in patients having HFrEF with concurrent cocaine use.
Methods:
We conducted a retrospective study of patients with a diagnosis of HFrEF between 2011 and 2014 based on International Classification of Diseases 9-Clinical Modification codes. We included patients aged 18 and older who tested positive for cocaine on a urine toxicology test obtained at the time of index admission. Patients were followed for 1 year. Multivariate logistic regression was used to assess the effect of BBT on the 30-day, all-cause and heart failure-related readmissions.
Results:
The 30-day readmission rates for BBT versus no BBT groups were 20% versus 41% (odds ratio [OR]: 0.17, 95% confidence interval [CI] = 0.05-0.56, P = .004) for heart failure-related readmissions and 25% versus 46% (OR: 0.19, 95% CI = 0.06-0.64, P = .007) for all-cause readmissions.
Conclusion:
The BBT reduced 30-day, all-cause and heart failure-related readmission rate but not 1-year mortality in patients having HFrEF with concurrent cocaine use.
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