Abstract 15128: Clinical Outcomes in Heart Failure Patients With Concurrent Cocaine Use

Abstract

Background: While cocaine use is associated with heart failure (HF) with reduced ejection fraction, the impact of cocaine use on HF outcomes including 30-day hospital readmission and survival has not been well described. Accordingly, this study evaluated the impact of cocaine use on 30-day hospital readmissions (heart failure and all cause) and mortality. Methods: We performed a case control study of HF patients with an index HF hospitalization at an academic safety net hospital in San Francisco between 2001-2019. 746 HF patients with history of cocaine use were matched to 746 HF patients without cocaine use, based on age, gender, and date of index hospitalization. We compared clinical characteristics, readmission rates, and mortality between these two groups. Results: Average age was 53 years and 79% were male. HF patients with cocaine use were more likely to be African American (69.6% vs. 29.8%, p<0.01), have hypertension, liver disease and concurrent use of methamphetamines and opioids. Rates of coronary artery disease, diabetes, chronic kidney disease, HIV, and chronic obstructive pulmonary disease were similar between the groups. There was no significant difference in prescription of guideline directed medical therapies at discharge. Within 30 days of index HF hospitalization, HF patients with cocaine use were more likely to attend follow up (91.8% vs 86.9%, p<0.01), but were more likely to be readmitted for HF (12.1% vs 7.4%, OR 1.75, p<0.01) or other causes (22.4% vs 14.7%, OR 1.67, p<0.01). Over the study period, cocaine use was associated with greater likelihood of death (27.9% vs 20.1%, p<0.01). Conclusions: HF patients with comorbid cocaine use were found to have higher likelihood of readmission or death following index HF hospitalization compared to HF patients without cocaine use. As cocaine use continues to grow it is critical to understand the mechanisms underlying cocaine induced cardiovascular pathophysiology, and to identify factors affecting readmission and mortality in this high risk group.