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Carvedilol Among Patients With Heart Failure With a Cocaine-Use Disorder.

Dahlia Banerji¹, Raza M Alvi², Maryam Afshar³

¹Cardiac MR PET CT Program, Department of Radiology, and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

JACC. Heart Failure

|August 31, 2019

Summary

Carvedilol therapy appears safe for heart failure patients with cocaine use disorder. It may reduce major adverse cardiovascular events, especially in those with reduced ejection fraction.

Keywords:

beta-blockers cocaine-use disorder heart failure

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Area of Science:

Cardiology
Pharmacology
Addiction Medicine

Background:

Heart failure (HF) management guidelines recommend carvedilol.
The safety of carvedilol in HF patients with cocaine use disorder (CUD) remains unestablished.
CUD is increasingly prevalent in HF populations, necessitating safety data.

Purpose of the Study:

To assess the safety and potential efficacy of carvedilol in patients hospitalized with heart failure and a co-occurring cocaine use disorder.
To evaluate major adverse cardiovascular events (MACE) in this specific patient subgroup.

Main Methods:

Single-center retrospective study of 503 hospitalized HF patients with CUD.
Patients were stratified based on carvedilol prescription (n=404) versus no prescription (n=99).
Subgroup analyses included ejection fraction (EF) strata; MACE defined as cardiovascular mortality and 30-day HF readmission.

Main Results:

Carvedilol and non-carvedilol groups had similar MACE rates overall (32% vs. 38%, p=0.16).
Patients with reduced EF (≤40%) taking carvedilol had significantly lower MACE rates (34% vs. 58%, p=0.02).
Multivariate analysis indicated carvedilol was associated with reduced MACE in HF patients with CUD (HR: 0.67; 95% CI: 0.481-0.863).

Conclusions:

Carvedilol therapy is suggested to be safe for heart failure patients with a cocaine use disorder.
Carvedilol may offer a protective effect, particularly for patients with reduced ejection fraction and CUD.