Abstract 17713: A Three year Retrospective Analysis of Adverse Cardiac Outcomes in Heart Failure Patients Using Cocaine on Beta-blockers

Abstract

Background: It is an established fact that beta-blockers (BB) improve survival in patients with HFrEF. However cocaine abusers with HFrEF are currently excluded from this life-saving treatment due to concerns with a theoretical risk of unopposed alpha adrenergic receptor-mediated coronary vasospasms and possible myocardial infarctions (MI). Our study seeks to compare heart failure (HF) outcomes in patients on beta blockers with surreptitious cocaine abuse to those not receiving beta blockers. Methods: From our HF registry, we retrospectively identified 132 patients admitted to the hospital for CHF with related complaints like chest pain or shortness of breath between 2006 and 2008 and cocaine positive drug test. We reviewed the concomitant use of BB in relation to the primary composite end points: MI, total ER visits, HF related admissions 2006-2008, ejection fraction (EF), mean BNP and all- cause mortality. Characteristics of patients with and without BB use were compared using chi-square for categorical and t-test for continuous variables. Considering the variance in baseline characteristics between patients, we also adjusted for co-founding factors like age, sex, Body mass index (BMI) and race before evaluating the independent relationship between BB use and the composite primary endpoints listed above. Results: BB were used in 60 patients (45%), no distinction was made between selective BBs or nonselective BBs. The analysis of our cohort data showed no significant difference in the number of MI (p - 0.819), ER visits (p - 0.627), HF- related admissions (p-0.382), mean BNP (p-0.480), EF (p-0.273) in HF patients using cocaine on BB vs those not on BB. Findings were similar after adjusting for cofounding variables - race, sex, BMI and race (OR for having an MI with BB use was 1.185[95% CI 0.277-5.069]). Conclusions: BB treatment of HFrEF with concomitant cocaine abuse may be safer than previously suggested. Prospectively randomized trials will be needed to clarify the safety of beta blockers in cocaine abusing HFrEF patients. Limitations: Our study was limited by the absence of distinction between selective and nonselective BB as alpha-blocking BBs like carvedilol have been proposed as safe since they can moderate the theoretical alpha mediated effects of cocaine.