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

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 41; no. 4; pp. 465 - 469
• Main Authors: Lopez, Persio D., Akinlonu, Adedoyin, Mene‐Afejuku, Tuoyo O., Dumancas, Carissa, Saeed, Mohammed, Cativo, Eder H., Visco, Ferdinand, Mushiyev, Savi, Pekler, Gerald
• Format: Journal Article
• Language: English
• Published: New York Wiley Periodicals, Inc 01.04.2018; John Wiley & Sons, Inc
• Subjects: Adrenergic beta-Antagonists - adverse effects; Adrenergic beta-Antagonists - therapeutic use; Beta blockers; Clinical Decision-Making; Clinical Investigations; Clinical Pharmacology; Cocaine; Cocaine-Related Disorders - complications; Cocaine-Related Disorders - diagnosis; Cocaine-Related Disorders - physiopathology; Ejection fraction; Female; General Clinical Cardiology/Adult; Heart Failure; Heart Failure - complications; Heart Failure - diagnosis; Heart Failure - drug therapy; Heart Failure - physiopathology; Humans; Male; Middle Aged; New York City; Patient Selection; Recovery of Function; Retrospective Studies; Risk Factors; Stroke Volume - drug effects; Time Factors; Treatment Outcome; Ventricular Function, Left - drug effects; General Clinical Cardiology/Adult; Heart Failure; Clinical Pharmacology
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.22897

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.