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A Protocol for Measuring Cue Reactivity in a Rat Model of Cocaine Use Disorder
Published on: June 18, 2018
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Outcomes in Patients With Heart Failure Using Cocaine
Jonah D Garry1, Anjali B Thakkar2, Matthew S Durstenfeld2
1Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
The American Journal of Cardiology
|May 26, 2022
Summary
Cocaine use increases mortality and hospital readmissions in heart failure patients. However, beta-blocker medications appear safe for managing cocaine users with heart failure with reduced ejection fraction.
Area of Science:
- Cardiology
- Clinical Outcomes Research
- Substance Use Disorders
Background:
- Cocaine is a known cardiovascular toxin.
- The effect of cocaine on heart failure (HF) outcomes is not well understood.
- Nonselective beta-blockers are tolerated in cocaine users with HF and reduced ejection fraction (HFrEF), but selective beta-blockers remain unevaluated.
Purpose of the Study:
- To determine if cocaine use is linked to worse clinical outcomes in heart failure patients.
- To assess the safety of prescribing beta-blockers upon discharge for cocaine users with HFrEF.
Main Methods:
- Single-center retrospective cohort study.
- Compared 738 cocaine users with 738 matched non-users hospitalized for incident HF (2001-2019).
- Assessed all-cause mortality and readmissions (all-cause and HF-specific). Evaluated beta-blocker safety in cocaine users with HFrEF.
Main Results:
- Cocaine use was associated with higher mortality (aHR 1.21) and 90-day readmissions (all-cause aHR 1.49; HF aHR 1.49), persisting at 1 year.
- In cocaine users with HFrEF, outcomes were similar regardless of metoprolol, carvedilol, or no beta-blocker prescription at discharge.
- No significant difference in 1-year mortality or 30-day readmission rates among cocaine users based on beta-blocker use.
Conclusions:
- Cocaine use is linked to increased all-cause mortality and HF readmissions.
- Both nonselective and selective beta-blockers may be safe for managing HFrEF patients who use cocaine.
