Dahlia Banerji1, Raza M Alvi2, Maryam Afshar3, Noor Tariq4, Adam Rokicki5, Connor P Mulligan1, Lili Zhang1, Malek O Hassan1, Magid Awadalla1, John D Groarke6, Tomas G Neilan5. 1. Cardiac MR PET CT Program, Department of Radiology, and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 2. Cardiac MR PET CT Program, Department of Radiology, and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Bronx-Lebanon Hospital Center of Icahn School of Medicine at Mount Sinai, Bronx, New York. Electronic address: ralvi@mgh.harvard.edu. 3. Bronx-Lebanon Hospital Center of Icahn School of Medicine at Mount Sinai, Bronx, New York. 4. Department of Medicine, Division of Cardiology, Yale New Haven Hospital of Yale University School of Medicine, New Haven, Connecticut. 5. Cardiac MR PET CT Program, Department of Radiology, and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 6. Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts.
Abstract
OBJECTIVES: This study sought to assess the safety of carvedilol therapy among heart failure (HF) patients with a cocaine-use disorder (CUD). BACKGROUND: Although carvedilol therapy is recommended among certain patients with HF, the safety and efficacy of carvedilol among HF patients with a CUD is unknown. METHODS: This was a single-center study of hospitalized patients with HF. Cocaine use was self-reported or defined as having a positive urine toxicology. Patients were divided by carvedilol prescription. Subgroup analyses were performed by strata of ejection fraction (EF) ≤40%, 41% to 49%, or ≥50%. Major adverse cardiovascular events (MACE) were defined as cardiovascular mortality and 30-day HF readmission. RESULTS: From a cohort of 2,578 patients hospitalized with HF in 2011, 503 patients with a CUD were identified, among whom 404 (80%) were prescribed carvedilol, and 99 (20%) were not. Both groups had similar characteristics; however, those prescribed carvedilol had a lower LVEF, heart rate, and N-terminal pro-B-type natriuretic peptide concentrations at admission and on discharge, and more coronary artery disease. Over a median follow-up of 19 months, there were 169 MACEs. The MACE rates were similar between the carvedilol and the non-carvedilol groups (32% vs. 38%, respectively; p = 0.16) and between those with a preserved EF (30% vs. 33%, respectively; p = 0.48) and were lower in patients with a reduced EF taking carvedilol (34% vs. 58%, respectively; p = 0.02). In a multivariate model, carvedilol therapy was associated with lower MACE among patients with HF with a CUD (hazard ratio: 0.67; 95% confidence interval; 0.481 to 0.863). CONCLUSIONS: Our findings suggest that carvedilol therapy is safe for patients with HF with a CUD and may be effective among those with a reduced EF.
OBJECTIVES: This study sought to assess the safety of carvedilol therapy among heart failure (HF) patients with a cocaine-use disorder (CUD). BACKGROUND: Although carvedilol therapy is recommended among certain patients with HF, the safety and efficacy of carvedilol among HF patients with a CUD is unknown. METHODS: This was a single-center study of hospitalized patients with HF. Cocaine use was self-reported or defined as having a positive urine toxicology. Patients were divided by carvedilol prescription. Subgroup analyses were performed by strata of ejection fraction (EF) ≤40%, 41% to 49%, or ≥50%. Major adverse cardiovascular events (MACE) were defined as cardiovascular mortality and 30-day HF readmission. RESULTS: From a cohort of 2,578 patients hospitalized with HF in 2011, 503 patients with a CUD were identified, among whom 404 (80%) were prescribed carvedilol, and 99 (20%) were not. Both groups had similar characteristics; however, those prescribed carvedilol had a lower LVEF, heart rate, and N-terminal pro-B-type natriuretic peptide concentrations at admission and on discharge, and more coronary artery disease. Over a median follow-up of 19 months, there were 169 MACEs. The MACE rates were similar between the carvedilol and the non-carvedilol groups (32% vs. 38%, respectively; p = 0.16) and between those with a preserved EF (30% vs. 33%, respectively; p = 0.48) and were lower in patients with a reduced EF taking carvedilol (34% vs. 58%, respectively; p = 0.02). In a multivariate model, carvedilol therapy was associated with lower MACE among patients with HF with a CUD (hazard ratio: 0.67; 95% confidence interval; 0.481 to 0.863). CONCLUSIONS: Our findings suggest that carvedilol therapy is safe for patients with HF with a CUD and may be effective among those with a reduced EF.
Authors: James McCord; Hani Jneid; Judd E Hollander; James A de Lemos; Bojan Cercek; Priscilla Hsue; W Brian Gibler; E Magnus Ohman; Barbara Drew; George Philippides; L Kristin Newby Journal: Circulation Date: 2008-03-17 Impact factor: 29.690
Authors: Kenzie L Preston; David H Epstein; Edward J Cone; Abraham T Wtsadik; Marilyn A Huestis; Eric T Moolchan Journal: J Anal Toxicol Date: 2002-10 Impact factor: 3.367
Authors: Philip A Poole-Wilson; Karl Swedberg; John G F Cleland; Andrea Di Lenarda; Peter Hanrath; Michel Komajda; Jacobus Lubsen; Beatrix Lutiger; Marco Metra; Willem J Remme; Christian Torp-Pedersen; Armin Scherhag; Allan Skene Journal: Lancet Date: 2003-07-05 Impact factor: 79.321