Carvedilol Among Patients With Heart Failure With a Cocaine-Use Disorder

Dahlia Banerji, Raza M. Alvi, Maryam Afshar, Noor Tariq, Adam Rokicki, Connor P. Mulligan, Lili Zhang, Malek O. Hassan, M. Awadalla, John D. Groarke, Tomas G. Neilan

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)771-778
Number of pages8
JournalJACC: Heart Failure
Issue number9
StatePublished - Sep 2019
Externally publishedYes


  • beta-blockers
  • cocaine-use disorder
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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