NYMC Faculty Publications

Clinical Outcomes of Beta-Blocker Therapy in Cocaine-Associated Heart Failure

Journal Title

International Journal of Cardiology

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Publication Date

February 2019




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.