Improvement in clinical outcomes of patients with heart failure and active cocaine use after β‐blocker therapy

Abstract

Background Cocaine use has a high prevalence in the United States and can be associated with significant cardiovascular disease, even in asymptomatic users. β‐Adrenergic receptor hyperactivation is the underlying pathophysiologic pathway of cocaine cardiotoxicity. β‐Blocker therapy is controversial in patients with active cocaine use. Hypothesis β‐Blocker therapy is associated with clinical improvement in patients with heart failure despite active cocaine use. Methods In a single‐center, retrospective chart analysis, patients with newly diagnosed heart failure and active cocaine use who had been started on β‐blocker therapy were reviewed. The New York Heart Association (NYHA) functional class and the left ventricular ejection fraction (LVEF) were recorded at baseline and after 12 monthsnthsnths of β‐blocker use. Patients were excluded if they had been on prior β‐blocker therapy, had other reasons for volume overload, had chronic kidney disease stages G4 or G5, or had a life expectancy <12 months. Results Thirty‐eight patients were identified; most were African American males. A statistically significant improvement was found in both NYHA functional class (P < 0.0001) and LVEF (P < 0.0001) after 12 months of β‐blocker therapy. No major adverse cardiovascular events occurred in this population. Conclusions β‐Blocker use in cocaine users with heart failure with a reduced ejection fraction is associated with a lower NYHA functional class and a higher LVEF at 12‐month follow‐up. No major adverse cardiovascular events were observed.

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

“…e use of cocaine was confirmed by self-reported history and positive urine toxicology in six studies [10,12,16,18,20,21], positive urine toxicology in another five [11,13,15,17,19], and only self-reported in one study [14]. Carvedilol (combined beta1,2 and alpha blocker) alone was used in five studies [11,12,14,15,21], carvedilol, labetalol (combined beta1,2 and alpha blocker), bisoprolol, metoprolol tartrate, and metoprolol succinate were used in one study [16], and carvedilol and metoprolol succinate were used in two studies [18,20]. Both cardioselective and noncardioselective beta blockers (not specified) were used in one study [13], and three studies did not specify the type of beta blockers used [10,17,19].…”

“…Of the 12 articles reviewed, ten were retrospective studies involving a review of medical records [10,11,13,[15][16][17][18][19][20][21], one study was a case series of four patients [12], and one was a case report [14]. e sample size ranged from 1 to 503 patients with a median of 111. e total number of patients was 1994.…”

“…Both cardioselective and noncardioselective beta blockers (not specified) were used in one study [13], and three studies did not specify the type of beta blockers used [10,17,19]. e primary outcomes were readmission (all cause and heart failure related) in nine studies [10-13, 15-17, 19, 20], mortality in seven studies [10,11,13,[15][16][17]19], LVEF improvement in six studies [12-14, 17, 18, 20], NYHA functional class in three studies [12,18,20], and major adverse cardiovascular events (MACEs) in four studies [16,18,20,21] as shown in Table 2.…”

“…Nine studies provided either partial or complete data on statistical measures [10,13,[15][16][17][18][19][20][21], and one study did not report any statistical outcomes [11]. Statistical analysis was not applicable for two studies (case series and case report) [12,14].…”

“…Due to the retrospective nature of studies, variance in analytic approaches, and incomplete statistical data (also because of only abstract publication), formal synthesis was not possible and risk of bias across studies could not be determined. Four original studies included had difference in statistical design and/or primary outcomes limiting the opportunity for metaanalysis [16,[18][19][20]. Table 2 summarizes the measured statistical outcomes of studies.…”