Background: Beta-blockers are first line agents for reduction of symptoms, hospitalization and mortality in heart failure patients with reduced ejection fraction (HFrEF). The safety and efficacy of continuous beta-blocker therapy (BBT) in patients who use cocaine remain controversial and available literature is limited. We aimed to evaluate clinical outcomes of BBT among HFrEF patients who use cocaine.
Methods: We conducted a retrospective chart review of 90 patients with a diagnosis of heart failure based on ICD9-CM codes and baseline ejection fraction (EF) <40% who tested positive for cocaine on urine toxicology test at the time of index admission. We included patients age 18 or older with at least 3 months of follow up. Baseline EF was obtained from the earliest available echocardiogram report in 2011 and repeat EF was obtained from follow up echocardiogram reports while on BBT. We described baseline patient characteristics, comorbidities and outcomes (change in EF during study period, re-hospitalizations and mortality).
Results: In our study population (mean age = 56.1 ± 7.8 years), the mean baseline EF was 24.1% (std=9.0). The mean overall change in EF among patients on continuous BBT was 1.9% (std=14.6; p-value=0.2) over a mean follow-up time of 15.5 months (std=8.6). Thirty-nine percent (n=35, mean follow up=15.7 months) of our study population had a decrease in EF (mean change= -10.6%; std=6.8), 22% (n=20, mean follow up=17.4 months) had no change in EF and 39% (n=35, mean follow up=14.3 months) had an increase in EF (mean change= +14.3%; std=7.5). There was an average of 3.2(std=3.3) re-hospitalizations. Ninety-two percent (n=83) were alive at the end of the study period.
Conclusion: Continuous beta-blocker therapy in HFrEF patients who abuse cocaine has variable effects on left ventricular EF. Large observational studies are needed to further elucidate the efficacy and safety of long-term beta-blocker therapy in this population.