Comparison of Frequency of Cardiovascular Events and Mortality in Patients With Heart Failure Using Versus Not Using Cocaine

Beta-blocker treatment improves left ventricular function, morbidity, and survival in patients with systolic heart failure (HF). However, there are limited data addressing the safety and efficacy of β blockers in the setting of cocaine use as there is a perceived risk of adverse outcomes. Our aim was to determine if beta-blocker treatment was safe in HF patients with a history of cocaine use compared with HF patients without history of cocaine use. We also examined whether effects differed between cardioselective versus noncardioselective β blockers. Ninety systolic HF patients with cocaine use were compared with 177 patients with nonischemic, systolic HF, and no cocaine use. Outcomes were HF readmissions, major adverse cardiovascular events, and death using multivariable Cox proportional hazard models adjusted for age, black race, hypertension, diabetes, coronary artery disease, renal insufficiency, and angiotensin-converting enzyme inhibitors. Beta-blocker treatment in systolic HF patients with cocaine use did not have significant differences in HF readmissions (hazard ratio [HR] 0.66, 95% CI 0.31 to 0.1.38), major adverse cardiovascular events (HR 0.58, 95% CI 0.27 to 1.09), death (HR 0.96, 95% CI 0.39 to 2.34), or all combined outcomes (HR 0.76, 95% CI 0.39 to 1.47) compared with beta-blocker treatment in HF patients without cocaine use. Within HF patients with cocaine use, mortality rates (HR 1.50, 95% CI 0.28 to 8.23) were not significantly different between patients treated with noncardioselective versus cardioselective β blockers. In conclusion, beta-blocker treatment in systolic HF patients with cocaine use was not associated with adverse outcomes.