Lopez PD, Akinlonu A, Mene-Afejuku TO, Dumancas C, Saeed M, Cativo EH, Visco F, Mushiyev S, Pekler G. Improvement in clinical outcomes of patients with heart failure and active cocaine use after β-blocker therapy.
Clin Cardiol 2018;
41:465-469. [PMID:
29663434 DOI:
10.1002/clc.22897]
[Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/05/2018] [Accepted: 01/06/2018] [Indexed: 12/11/2022] Open
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.
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