Clinical Outcomes of Beta-Blocker Therapy in Cocaine-Associated Heart Failure
BACKGROUND: Cocaine is associated with deleterious effects in the heart, including HFrEF. Although beta-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 beta-blocker therapy than when they do not. METHODS: We performed a retrospective analysis of 72 beta-blocker-naive patients with HFrEF and active cocaine use. Patients who were prescribed beta-blockers as part of their therapy were compared to those who were not, and clinical and structural outcomes were compared after 12months of treatment. RESULTS: When patients with HFrEF and active cocaine use received beta-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 beta-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 beta-blockade than those who did not. CONCLUSIONS: beta-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.
Lopez, P., Akinlonu, A., Mene-Afejuku, T., Dumancas, C., Saeed, M., Cativo, E., Visco, F., Mushiyev, S., & Pekler, G. (2019). Clinical Outcomes of Beta-Blocker Therapy in Cocaine-Associated Heart Failure. International Journal of Cardiology, 277, 153-158. https://doi.org/10.1016/j.ijcard.2018.08.058