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.

中文翻译：

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卡维地洛用于可卡因使用障碍的心力衰竭患者。

目标

这项研究旨在评估卡维地洛治疗对可卡因使用障碍（CUD）的心力衰竭（HF）患者的安全性。

背景

尽管在某些心力衰竭患者中推荐使用卡维地洛治疗，但对于有CUD的心力衰竭患者，卡维地洛的安全性和有效性尚不明确。

方法

这是对住院的HF患者的单中心研究。可卡因的使用是自我报告的或定义为尿毒理学阳性。患者按卡维地洛处方分开。通过射血分数（EF）≤40％，41％至49％或≥50％的分层进行亚组分析。主要不良心血管事件（MACE）定义为心血管疾病死亡率和30天HF再入院。

结果

在2011年的2578例心力衰竭住院患者中，发现503例CUD患者，其中404（80％）处方卡维地洛，而99例（20％）则未使用卡维地洛。两组具有相似的特征。然而，那些处方卡维地洛在入院和出院时具有较低的LVEF，心律和N端pro-B型利钠肽浓度，并且冠心病的发生率更高。在19个月的中位随访中，有169例MACE。卡维地洛组和非卡维地洛组之间的MACE发生率相似（分别为32％和38％； p = 0.16）以及EF保留组之间的MACE发生率（分别为30％和33％； p = 0.48）和EF降低的患者服用卡维地洛的比例较低（分别为34％和58％； p = 0.02）。在多元模型中，

结论

我们的研究结果表明卡维地洛治疗对于伴有CUD的HF患者是安全的，并且在EF降低的患者中可能是有效的。