Persio D Lopez1, Adedoyin Akinlonu2, Tuoyo O Mene-Afejuku2, Carissa Dumancas2, Mohammed Saeed2, Eder H Cativo2, Ferdinand Visco3, Savi Mushiyev3, Gerald Pekler3. 1. Department of Medicine, Health+Hospitals/Metropolitan Hospital Center, New York, NY, USA; New York Medical College, Valhalla, NY, USA. Electronic address: pd.research@icloud.com. 2. Department of Medicine, Health+Hospitals/Metropolitan Hospital Center, New York, NY, USA; New York Medical College, Valhalla, NY, USA. 3. Division of Cardiology, Department of Medicine, Health+Hospitals/Metropolitan Hospital Center, New York, NY, USA; New York Medical College, Valhalla, NY, USA.
Abstract
BACKGROUND: Cocaine is associated with deleterious effects in the heart, including HFrEF. Although β-blockers are recommended for this condition in other populations, their use is discouraged in cocaine users due to the possibility of exacerbating cocaine-related cardiovascular complications. This study was designed to determine if patients with heart failure and a reduced ejection fraction (HFrEF) who continue to use cocaine have better outcomes when they receive β-blocker therapy than when they do not. METHODS: We performed a retrospective analysis of 72 β-blocker-naïve patients with HFrEF and active cocaine use. Patients who were prescribed β-blockers as part of their therapy were compared to those who were not, and clinical and structural outcomes were compared after 12 months of treatment. RESULTS: When patients with HFrEF and active cocaine use received β-blocker therapy, they were more likely to have an improvement in their New York Heart Association functional class (p = 0.0106) and left ventricular ejection fraction (p = 0.0031) than when they did not receive β-antagonists. In addition, the risk of cocaine-related cardiovascular events (p = 0.0086) and of heart failure hospitalizations (p = 0.0383) was significantly lower in patients who received β-blockade than those who did not. CONCLUSIONS: β-Blocker therapy is associated with improvement in the exercise tolerance and the left ventricular ejection fraction in patients with HFrEF and active cocaine use. They are also associated with a lower incidence of cocaine-related cardiovascular events and HFrEF-related readmissions.
BACKGROUND:Cocaine is associated with deleterious effects in the heart, including HFrEF. Although β-blockers are recommended for this condition in other populations, their use is discouraged in cocaine users due to the possibility of exacerbating cocaine-related cardiovascular complications. This study was designed to determine if patients with heart failure and a reduced ejection fraction (HFrEF) who continue to use cocaine have better outcomes when they receive β-blocker therapy than when they do not. METHODS: We performed a retrospective analysis of 72 β-blocker-naïve patients with HFrEF and active cocaine use. Patients who were prescribed β-blockers as part of their therapy were compared to those who were not, and clinical and structural outcomes were compared after 12 months of treatment. RESULTS: When patients with HFrEF and active cocaine use received β-blocker therapy, they were more likely to have an improvement in their New York Heart Association functional class (p = 0.0106) and left ventricular ejection fraction (p = 0.0031) than when they did not receive β-antagonists. In addition, the risk of cocaine-related cardiovascular events (p = 0.0086) and of heart failure hospitalizations (p = 0.0383) was significantly lower in patients who received β-blockade than those who did not. CONCLUSIONS: β-Blocker therapy is associated with improvement in the exercise tolerance and the left ventricular ejection fraction in patients with HFrEF and active cocaine use. They are also associated with a lower incidence of cocaine-related cardiovascular events and HFrEF-related readmissions.
Authors: Dahlia Banerji; Raza M Alvi; Maryam Afshar; Noor Tariq; Adam Rokicki; Connor P Mulligan; Lili Zhang; Malek O Hassan; Magid Awadalla; John D Groarke; Tomas G Neilan Journal: JACC Heart Fail Date: 2019-09 Impact factor: 12.035