Source Study outcomes tested Follow-up period Study outcomes (statistical analysis) Conclusion Level of evidence [23 ] Ahmed et al. [10 ] Readmission rates and mortality 6 months Readmission rates (HR, 1.8; 95% CI, 1.16–2.7; Readmission rate higher in cocaine users. No difference in mortality 3 Finks et al. [11 ] ED care, all-cause ED and readmission rates, length of stay, recurrent MI, and mortality Not provided Not provided Carvedilol in patients with cocaine-induced chest pain and heart failure was safe 4 Littmann et al. [12 ] Readmission rates, LVEF, and NYHA class 6–13 months Not applicable Carvedilol can improve LVEF and NYHA functional class in patients with ongoing cocaine use 4 Akpa et al. [13 ] MI, ED visits, HF-related admissions, LVEF, mean BNP, and all-cause mortality Not provided MI occurrence (OR, 1.185; 95% CI, 0.277–5.069; BB treatment of HFrEF with concomitant cocaine abuse may be safe 4 Ocal et al. [14 ] LVEF 1 week Not applicable Successful treatment of cocaine-induced cardiotoxicity with carvedilol therapy 5 Finks et al. [15 ] All-cause ED and readmission rates, recurrent MI rates, new onset HF, and mortality 6 months ED visits (1.65 ± 1.88 vs 1.97 ± 2.39, Carvedilol for cocaine-induced chest pain did not worsen 6-month outcomes in veterans with HFrEF and MI 4 Nguyen et al. [16 ] HF readmissions, major adverse CV events, and death 4000 days HF readmissions (HR, 0.66; 95% CI, 0.31–1.38), BB therapy in systolic HF patients with cocaine use was not associated with adverse outcomes. 3 Egbuche et al. [17 ] LVEF, readmission rates, and mortality 15.5 ± 8.6 months Overall change in LVEF (1.9 ± 14.6, Continuous BB therapy in HFrEF patients with cocaine abuse has variable effects on LVEF 3 Lopez et al. [18 ] NYHA functional class, LVEF, and major adverse CV events 12 months NYHA (S = –108, S = 141.5, BB therapy in cocaine users with HFrEF is associated with lower NYHA class and higher LVEF. No MACE was observed. 3 Egbuche et al. [19 ] 30-day all-cause readmissions, HF-related readmissions, and mortality 12 months All-cause readmissions, 30 days (OR, 0.19; 95% CI, 0.06–0.64; BB therapy reduces 30-day readmission rate but not one-year mortality in HFrEF patients with concurrent cocaine use 3 Lopez et al. [20 ] NYHA functional class, LVEF, CRCE, and HF readmissions 12 months Improvement in NYHA functional class (RR, 2.24; 95% CI, 1.14–4.41; BB therapy is associated with improvement in NYHA functional class and LVEF, lower incidence of CRCE, and HF-related readmissions in HFrEF patients with active cocaine use. 3 Alvi et al. [21 ] Major adverse CV events 720 days MACE similar in entire cohort (32% vs 38%, Carvedilol is safe and may be effective among HF patients who use cocaine 3
BB, beta blocker; BNP, brain natriuretic peptide; CI, confidence interval; CRCE, cocaine-related cardiovascular events; CV, cardiovascular; ED, emergency department; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; HFbEF, heart failure with borderline ejection fraction; HFpEF, heart failure with preserved ejection fraction; HR, hazard ratio; LVEF, left ventricular ejection fraction; MACE, major adverse cardiovascular events; MI, myocardial infarction; NS, nonsignificant; NYHA, New York Heart Association; OR, odds ratio; RR, relative risk.
