Carvedilol Among Patients With Heart Failure With a Cocaine-Use Disorder

Banerji, Dahlia; Alvi, Raza M.; Afshar, Maryam; Tariq, Noor; Rokicki, Adam; Mulligan, Connor P.; Zhang, Lili; Hassan, Mahad M.; Awadalla, Magid; Groarke, John D.; Neilan, Tomas G.

doi:10.1016/j.jchf.2019.06.010

Cited by 9 publications

(9 citation statements)

References 41 publications

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“…Another separate retrospective cohort study looked at 503 patients with heart failure and a comorbid cocaine-use disorder treated with carvedilol. 10 Patients with heart failure with reduced ejection fraction treated with carvedilol had a lower rate of cardiovascular death and 30-day hospital readmission than those without β-blockade, despite 69% of participants reporting ongoing cocaine use at least once per week. Taken together, these results suggest that β-blockers are not only safe but effective.…”

Section: Avoidance Of β-Blockers In Patients Who Use Stimulants Is Not Supported By Good Evidencementioning

confidence: 93%

Avoidance of β-blockers in patients who use stimulants is not supported by good evidence

Wilson

Pitcher

Bach

2022

CMAJ

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Section: Avoidance Of β-Blockers In Patients Who Use Stimulants Is Not Supported By Good Evidencementioning

confidence: 93%

Avoidance of β-blockers in patients who use stimulants is not supported by good evidence

Wilson

Pitcher

Bach

2022

CMAJ

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“…Banerji et al published the safety data of carvedilol usage among 2,578 individuals with heart failure and CUD. It showed that carvedilol was safe to use in these populations without any adverse outcomes [16].…”

Section: Discussionmentioning

confidence: 99%

Role of Stent Versus Thrombolysis in Management of Cocaine-Induced ST-Elevation Myocardial Infarction

Kyaw

2020

Cureus

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Cocaine has been used increasingly nowadays because of its abundant availability and recreational effects. Along with that, we have been experiencing many cases presenting with cocaine intoxication and withdrawal effects, including hypertension and chest pain syndrome. In the modern era, many medical advances related to myocardial infarction treatment have been made, including not only medical therapy but also urgent or emergent reperfusion, and revascularization therapies. In percutaneous coronary revascularization therapy, a secondgeneration drug-eluting stent (DES) with dual antiplatelet therapy is the first-line treatment compared to bare-metal stent (BMS) with significant reduced risk of stent thrombosis and restenosis. However, there is limited clinical and research data on how to approach cocaineinduced myocardial infarction (CIMI) and it remains unclear what would be the optimal stent type we should use in CIMI. We, hereby, would like to describe a case of cocaine-related STsegment elevation myocardial infarction (STEMI) requiring emergent percutaneous coronary intervention with a DES and clinical outcome. We also performed a literature review of cocaine-induced acute myocardial infarction management.

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“…Nonselective beta-blockers block alpha as well as beta receptors. In an observational study of 2578 patients admitted to a hospital for acute heart failure, 20% (n = 503) had cocaine-associated heart failure [ 45 ]. The primary endpoint of this study was a major adverse cardiac event (MACE), including a 30-day heart failure hospital re-admission.…”

Section: Reviewmentioning

confidence: 99%

“…Among those with an ejection fraction <40%, there was a significantly lower rate of MACE in those taking carvedilol than not (34% vs 58%, p = 0.02), but in patients with an ejection fraction >40%, MACE rates were similar among those taking and those not taking carvedilol. Thus, carvedilol may be effective for active cocaine users with cocaine-associated heart failure and ejection fractions <40% [ 45 ]. The particular interest in this study was that the type of cocaine and frequency of cocaine use did not seem to influence the results [ 45 ].…”

Section: Reviewmentioning

confidence: 99%

“…Thus, carvedilol may be effective for active cocaine users with cocaine-associated heart failure and ejection fractions <40% [ 45 ]. The particular interest in this study was that the type of cocaine and frequency of cocaine use did not seem to influence the results [ 45 ]. Of course, this study is limited in that it was an observational, single-center study and only carvedilol was used due to institutional practices.…”

Section: Reviewmentioning

confidence: 99%

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Cocaine and Cardiotoxicity: A Literature Review

Pergolizzi¹,

Magnusson²,

LeQuang³

et al. 2021

Cureus

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Long-term cocaine use, as well as acute cocaine use, is associated with adverse cardiovascular consequences, including arrhythmias, angina, myocardial infarction, heart failure, and other conditions. Over the long term, cocaine can result in structural changes to the heart such as increased left-ventricular mass and decreased left-ventricular end-diastolic volume. Patients arriving with cocaine-associated cardiovascular complaints may not be forthcoming about their cocaine or polysubstance abuse or may be unresponsive. The role of beta-blockers, a first-line treatment for many forms of heart disease, is controversial in this population. Cocaine is a powerful sympathomimetic agent, and it was thought that beta-blockade would result in unopposed alpha-adrenergic stimulation and adverse consequences. A number of small, singlecenter, retrospective and observational studies suggest that beta-blockers may be safe, effective, and beneficial in this population. Further study is needed to clarify the role of beta-blockers in this population.

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Carvedilol Among Patients With Heart Failure With a Cocaine-Use Disorder

Cited by 9 publications

References 41 publications

Avoidance of β-blockers in patients who use stimulants is not supported by good evidence

Avoidance of β-blockers in patients who use stimulants is not supported by good evidence

Role of Stent Versus Thrombolysis in Management of Cocaine-Induced ST-Elevation Myocardial Infarction

Cocaine and Cardiotoxicity: A Literature Review

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