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.

Keywords: Clinical Pharmacology; General Clinical Cardiology/Adult; Heart Failure.

Figure 1

Changes in NYHA functional classification after 12 months of β‐blocker therapy. Most patients were in NYHA functional class III at the time of diagnosis, and 4 of them were in class IV. After a year of β‐blocker therapy, a significant number of these patients had improved to NYHA functional class I and II (asterisk indicates statistical significance). Abbreviations: NYHA, New York Heart Association

Figure 2

Changes in LVEF after 12 months of β‐blocker therapy. A significant improvement in LVEF was noticed after 12 months of β‐blocker therapy. The proportion of patients in the lower categories decreased, and >30% of patients had improvement of their LVEF to near‐normal levels (asterisk indicates statistical significance). Abbreviations: LVEF, left ventricular ejection fraction