Clinical outcomes of Β-blocker therapy in cocaine-associated heart failure. (15th February 2019) - Lopez, Persio D.
Abstract: Background: Cocaine is associated with deleterious effects in the heart, including HFrEF. Although β-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 β-blocker therapy than when they do not. Methods: We performed a retrospective analysis of 72 β-blocker-naïve patients with HFrEF and active cocaine use. Patients who were prescribed β-blockers as part of their therapy were compared to those who were not, and clinical and structural outcomes were compared after 12 months of treatment. Results: When patients with HFrEF and active cocaine use received β-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 β-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 β-blockade than those who did not. Conclusions: β-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. Highlights: β-blockers lead to improvement of exercise tolerance in active cocaine users with heart failure. Dramatic improvement of the left ventricular ejection fraction is also seen in these patients when treated with β-blockers. The incidence of cocaine-related cardiovascular events is lower in these patients when they receive β-blockers. β-blockers also reduce the risk of heart failure-related hospitalizations in this population.