Author + information
- Received March 13, 2019
- Revision received June 19, 2019
- Accepted June 20, 2019
- Published online August 26, 2019.
- Dahlia Banerji, MDa,
- Raza M. Alvi, MDa,b,∗ (, )
- Maryam Afshar, MDb,
- Noor Tariq, MDc,
- Adam Rokicki, BSa,d,
- Connor P. Mulligan, BAa,
- Lili Zhang, MD, MSa,
- Malek O. Hassan, MDa,
- Magid Awadalla, MDa,
- John D. Groarke, MD, MPHe and
- Tomas G. Neilan, MD, MPHa,d
- aCardiac MR PET CT Program, Department of Radiology, and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- bBronx-Lebanon Hospital Center of Icahn School of Medicine at Mount Sinai, Bronx, New York
- cDepartment of Medicine, Division of Cardiology, Yale New Haven Hospital of Yale University School of Medicine, New Haven, Connecticut
- dDivision of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- eDepartment of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Raza M. Alvi, Cardiac MR PET CT Program, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, Massachusetts 02114.
Objectives This study sought to assess the safety of carvedilol therapy among heart failure (HF) patients with a cocaine-use disorder (CUD).
Background Although carvedilol therapy is recommended among certain patients with HF, the safety and efficacy of carvedilol among HF patients with a CUD is unknown.
Methods This was a single-center study of hospitalized patients with HF. Cocaine use was self-reported or defined as having a positive urine toxicology. Patients were divided by carvedilol prescription. Subgroup analyses were performed by strata of ejection fraction (EF) ≤40%, 41% to 49%, or ≥50%. Major adverse cardiovascular events (MACE) were defined as cardiovascular mortality and 30-day HF readmission.
Results From a cohort of 2,578 patients hospitalized with HF in 2011, 503 patients with a CUD were identified, among whom 404 (80%) were prescribed carvedilol, and 99 (20%) were not. Both groups had similar characteristics; however, those prescribed carvedilol had a lower LVEF, heart rate, and N-terminal pro–B-type natriuretic peptide concentrations at admission and on discharge, and more coronary artery disease. Over a median follow-up of 19 months, there were 169 MACEs. The MACE rates were similar between the carvedilol and the non-carvedilol groups (32% vs. 38%, respectively; p = 0.16) and between those with a preserved EF (30% vs. 33%, respectively; p = 0.48) and were lower in patients with a reduced EF taking carvedilol (34% vs. 58%, respectively; p = 0.02). In a multivariate model, carvedilol therapy was associated with lower MACE among patients with HF with a CUD (hazard ratio: 0.67; 95% confidence interval; 0.481 to 0.863).
Conclusions Our findings suggest that carvedilol therapy is safe for patients with HF with a CUD and may be effective among those with a reduced EF.
Drs. Banerji and Alvi were supported by U.S. National Institutes of Health/National Heart, Lung, and Blood Institute grant 5T32HL076136. Dr. Groarke has received research support from Amgen. Dr. Neilan is supported by a gift from A. Curt Greer and Pamela Kohlberg; National Institutes of Health/National Heart, Lung, and Blood Institute grants R01HL130539-01A1, 1R01HL137562-01A1, and K24HL113128-06; and National Institutes of Health/Harvard Center for AIDS Research grant P30 AI060354; and is a consultant for Parexel, Bristol-Myers Squibb, Aprea Therapeutics, and Intrinsic Imaging. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 13, 2019.
- Revision received June 19, 2019.
- Accepted June 20, 2019.
- 2019 American College of Cardiology Foundation
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