Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Division of Cardiology, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California.
Am J Cardiol. 2022 Aug 1;176:66-72. doi: 10.1016/j.amjcard.2022.04.028. Epub 2022 May 23.
Cocaine is an established cardiovascular toxin, but the impact of cocaine use on clinical outcomes in heart failure (HF) remains unknown. Although nonselective β-blocker use in cocaine users with HF and reduced ejection fraction (HFrEF) appears to be safely tolerated, selective β-blockers have not been evaluated. This study aimed to assess whether cocaine use is associated with worse clinical outcomes in patients with HF and evaluate the safety of β-blocker prescription upon discharge in cocaine users with HFrEF. This was a single-center retrospective cohort study of patients with incident HF hospitalization at a safety-net hospital. Primary outcomes included all-cause mortality and readmissions, including HF. Cocaine users were compared with nonusers matched by age, gender, and year of index admission. In cocaine users with HFrEF, outcomes were compared according to β-blocker prescription at discharge. From 2001 to 2019, 738 cocaine users were identified and compared with 738 matched nonusers. Cocaine use was associated with increased mortality (adjusted hazard ratio [HR] 1.21; 95% confidence interval [CI] 1.00 to 1.48) and 90-day readmission (all-cause: adjusted HR 1.49; 95% CI 1.20 to 1.85; HF: adjusted HR 1.49; 95% CI 1.10 to 2.01), persisting at 1 year. In cocaine users who were prescribed metoprolol, carvedilol, or no β-blocker at discharge, the rates of 1-year mortality and 30-day readmission were similar. In conclusion, cocaine use is associated with increased all-cause mortality, HF readmission, and all-cause readmission. Both nonselective and selective β-blocker may be safe in managing patients with HFrEF and cocaine use.
可卡因是一种已被证实的心血管毒素，但可卡因使用对心力衰竭（HF）患者临床结局的影响尚不清楚。虽然在 HF 合并射血分数降低（HFrEF）的可卡因使用者中使用非选择性β受体阻滞剂似乎可以安全耐受，但尚未评估选择性β受体阻滞剂。本研究旨在评估可卡因使用与 HF 患者临床结局恶化的相关性，并评估 HFrEF 可卡因使用者出院时β受体阻滞剂处方的安全性。这是一项单中心回顾性队列研究，纳入了一家社区医院的 HF 住院患者。主要结局包括全因死亡率和再入院率，包括 HF 再入院。可卡因使用者与年龄、性别和入院年份相匹配的非使用者进行比较。在 HFrEF 的可卡因使用者中，根据出院时β受体阻滞剂的处方情况比较结局。2001 年至 2019 年，共纳入 738 例可卡因使用者，并与 738 例匹配的非使用者进行比较。可卡因使用与死亡率增加（校正后的风险比 [HR] 1.21；95%置信区间 [CI] 1.00 至 1.48）和 90 天再入院（全因：校正后的 HR 1.49；95% CI 1.20 至 1.85；HF：校正后的 HR 1.49；95% CI 1.10 至 2.01）相关，这种相关性在 1 年内仍然存在。在出院时接受美托洛尔、卡维地洛或未使用β受体阻滞剂治疗的可卡因使用者中，1 年死亡率和 30 天再入院率相似。总之，可卡因使用与全因死亡率、HF 再入院率和全因再入院率增加相关。非选择性和选择性β受体阻滞剂在治疗 HFrEF 合并可卡因使用的患者时可能都是安全的。
