161 - Effect of Beta-Blocker Therapy on Hospital Readmission and Mortality in Heart Failure Patients with Ongoing Cocaine Use

Abstract

Background: Beta blockers are first line agents for reduction of symptoms, hospitalization and mortality in heart failure patients with reduced ejection fraction (HFrEF). However, the safety and efficacy of continuous beta-blocker therapy (BBT) in patients who actively use cocaine remain controversial and available literature is limited. We aimed to evaluate the effect of BBT on hospital readmission and mortality in HFrEF patients with ongoing cocaine use. Methods: We conducted a retrospective chart review of patients with a new diagnosis of HFrEF between 2011 and 2014 based on ICD9-CM codes. We included patients aged 18 and older who tested positive for cocaine on a urine toxicology test obtained at the time of index admission. Patients were followed for 1 year. We assessed for Beta-blocker prescription rate at the time of discharge from the index admission. A multivariate logistic regression was used to assess the effect of BBT on the 30-day all-cause and heart failure related readmissions. The 1-year mortality rate was also reported. Results: In our study population N = 268 and mean age [in yrs] = 54 (std = 6.9), the beta-blocker prescription rate is 86.2%. The 30-day readmission rate for BBT vs no BBT groups were 20% vs 41% (OR 0.17, 95% CI = 0.05–0.56, P = .004) for heart-failure related readmissions and 25% vs 46% (OR 0.19, 95% CI = 0.06–0.64, P = .007) for all-cause readmissions. The 1-year mortality rates for BBT vs no BBT groups were 5% vs 8% (OR 0.88, 95% CI = 0.17–7.19, P = .91). Conclusion: Physicians continue to prescribe outpatient Beta-blocker for most HFrEF patients regardless of cocaine-use status. BBT reduces 30-day all-cause and heart failure related readmission rate but not 1-year mortality in HFrEF patients with ongoing cocaine use. Large observational studies are needed to further elucidate the efficacy and safety of continuous BBT in this population.