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Published on: June 18, 2018
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.
Insights
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.
Abstract:
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.
