Beta Blocker Therapy in Heart Failure Patients with Active Cocaine Use: A Systematic Review

Abstract

Background. Cocaine use is associated with multiple cardiovascular complications including heart failure. The use of different types of beta blockers in heart failure patients with active cocaine use is still a matter of debate. In this review, our objective is to systematically review the available literature regarding the use of beta blockers in the treatment of heart failure patients with concurrent cocaine use. Methods. PubMed, EMBASE, Web of Science, and Clinical Trials.gov were searched from inception to March 2019 using the Medical Subject Headings (MeSH) terms “cocaine”, “heart failure”, “beta blocker,” and “cardiomyopathy”. Only studies containing the outcomes of heart failure patients with active cocaine use who were treated with beta blockers were included. Results. The search resulted in 2072 articles out of which 12 were finally included in the review. A total number of participants were 1994 with a median sample size of 111. Most of the studies were retrospective in nature with Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence from 3 to 5. The main primary outcomes included readmission rates, mortality, left ventricular ejection fraction (LVEF) improvement, New York Heart Association (NYHA) functional class, and major adverse cardiovascular events (MACEs). In the studies analyzed, beta blockers were found to have either a beneficial or a neutral effect on primary outcomes in heart failure patients with active cocaine use. Conclusion. The use of beta blocker therapy appears to be safe and beneficial in heart failure patients with active cocaine use, although the evidence is not robust. Furthermore, large-scale studies are required to confirm this finding.

Association of Opioid and Stimulant Use Disorder Diagnoses With Fatal and Nonfatal Overdose Among People With a History of Incarceration

“…For example, stimulant use is a known risk factor for CVD; however, substance use is generally absent from CVD risk assessments and treatment plans. 42 Furthermore, despite evidence that β-blockers are a safe and effective intervention for heart failure among people who use cocaine 43,44 their use in this population is often avoided, due in part to stigma and misinformation. 45 Consistent with prior studies, 11 NFOD events made up approximately 94% of all overdose events in this study and the incidence of NFOD was more than 15 times that of fatal events.…”

“…For example, stimulant use is a known risk factor for CVD; however, substance use is generally absent from CVD risk assessments and treatment plans . Furthermore, despite evidence that β-blockers are a safe and effective intervention for heart failure among people who use cocaine their use in this population is often avoided, due in part to stigma and misinformation …”

Things We Do for No Reason™: Discontinuing β‐blockers in patients who use cocaine

“…A recent systematic review also supports use of β-blockers as a component of guideline-directed medical therapy in patients with cocaine use and comorbid HFrEF, citing improvements in the New York Heart Association functional class, left ventricular ejection fraction, and 30-day readmission rate. 13 Altogether, these studies encourage the continued use of β-blocker therapy in patients with cocaine use, both during hospitalization and on discharge.…”

Cocaine and Cardiotoxicity: A Literature Review

“…There is some weak evidence in support of the use of beta-blockers among cocaine users with heart disease. In a systematic review (n = 1994 from 12 studies), it was found that beta-blockers conferred either a beneficial or a neutral effect on primary outcomes in heart failure in patients actively using cocaine [ 44 ]. It should be noted that there are no large-scale studies on beta-blockade in active cocaine users and the information from this meta-analysis comes mainly from small, single-center, retrospective studies [ 44 ].…”

“…In a systematic review (n = 1994 from 12 studies), it was found that beta-blockers conferred either a beneficial or a neutral effect on primary outcomes in heart failure in patients actively using cocaine [ 44 ]. It should be noted that there are no large-scale studies on beta-blockade in active cocaine users and the information from this meta-analysis comes mainly from small, single-center, retrospective studies [ 44 ]. Furthermore, this study evaluated patients with heart failure, which is not the only clinical cardiovascular manifestation of long-term cocaine use.…”