How cocaine use affects outcomes for hospitalized heart failure patients
Among hospitalized heart failure (HF) patients, cocaine use is associated with higher risks of long-term mortality and readmission within 90 days, according to a new analysis published in the American College of Cardiology.[1]
“Cocaine is theorized to worsen cardiomyopathy through catecholamine surge, endothelial dysfunction, prothrombotic effects, and impaired calcium handling,” wrote first author Jonah D. Garry, MD, of the division of cardiovascular medicine at Vanderbilt University Medical Center “However, the clinical impact of cocaine use in patients with HF remains poorly described.”
Gray et al. performed a retrospective study of more than 3,000 hospitalizations for HF from January 2001 to July 2019 at a single U.S. facility. Nearly 800 of those patients were using cocaine at the time of the hospitalization. The researchers matched 738 HF patients taking cocaine 1:1 with 738 HF patients who were not using cocaine.
While the rates of most comorbidities were the same between these two groups, hypertension was seen in 88.5% of cocaine users and 82.8% of nonusers. Alcohol, opiate and methamphetamine use were all much more common among cocaine users.
Overall, the team found, all-cause mortality was comparable among cocaine users (13.2%) and nonusers (11.3%) after one year. After five years, however, all-cause mortality was 36.7% among cocaine users and 29.2% among nonusers. After 10 years, it was 45.5% among cocaine users and 35.8% among nonusers.
Both all-cause readmission and HF readmission rates were consistently higher among cocaine users than nonusers. This includes the rates after 30 days, 90 days and one year. After adjusting for certain variables, cocaine use was no longer linked to HF readmission after 30 days, but the link to HF readmission after 90 days remains in place.
“Clinicians caring for patients with HF who use cocaine should be aware of the elevated rates of readmission and mortality in this high-risk patient population,” the authors wrote. “These patients may benefit from coronary artery disease screening, aggressive use of antihypertensives, and early employment of guideline-directed therapies. Further research directed toward elucidating the mechanisms of cocaine-induced cardiovascular toxicity may be useful in devising management strategies. Although not assessed in this study, psycho-socio-economic factors may play a significant role in adverse outcomes and warrant further investigation.”
Can beta-blockers help treat HF patients who are using cocaine?
Among 133 HF patients who were using cocaine, 133 presented with a reduced left ventricular ejection fraction (LVEF). While 104 of those patients were taking a beta-blocker, the other 29 were not. Both selective and nonselective beta-blockers appeared to be safe for managing these patients.
“Theoretically, carvedilol would be preferred over metoprolol for its alpha-blockade effect, but this may not translate into clinical outcomes,” the group wrote. “The advantages of once-a-day dosing and decreased blood pressure effect, allowing for ease of titration and compliance, may outweigh the hypothesized pharmacologic benefit.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.