Effect of ß-blocker Therapy on Hospital Readmission and Mortality in Heart Failure Patients With Concurrent Cocaine Use.

BACKGROUND: ß-Blockers are first-line agents for reduction in symptoms, hospitalization, and mortality in patients with heart failure having reduced ejection fraction (HFrEF). However, the safety and efficacy of continuous ß-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 patients having HFrEF with concurrent cocaine use. METHODS: We conducted a retrospective study of patients with a diagnosis of HFrEF between 2011 and 2014 based on International Classification of Diseases 9-Clinical Modification 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. Multivariate logistic regression was used to assess the effect of BBT on the 30-day, all-cause and heart failure-related readmissions. RESULTS: The 30-day readmission rates for BBT versus no BBT groups were 20% versus 41% (odds ratio [OR]: 0.17, 95% confidence interval [CI] = 0.05-0.56, P = .004) for heart failure-related readmissions and 25% versus 46% (OR: 0.19, 95% CI = 0.06-0.64, P = .007) for all-cause readmissions. CONCLUSION: The BBT reduced 30-day, all-cause and heart failure-related readmission rate but not 1-year mortality in patients having HFrEF with concurrent cocaine use.

Serum Ferritin Levels in Blacks Without Known Cardiovascular Disease (from the Jackson Heart Study).

There has been conflicting results regarding the role of ferritin, a nonspecific marker of systemic inflammation, in the development of coronary heart disease (CHD). We aimed to evaluate the association of serum ferritin with incident CHD, incident stroke, and subclinical measurements of atherosclerosis among blacks. For our prospective study, we utilized data from the Jackson Heart Study. Eligible participants (n = 4,659) who were free from CHD were enrolled in 2000 to 2004. The participants' baseline serum ferritin levels were obtained, and they were followed up for an average of 8 years to identify incident CHD events and incident stroke. We used multivariate linear regression and Cox proportional hazard models to evaluate the association of serum ferritin with incident CHD events and incident stroke. The age-adjusted correlations between ferritin and specific study covariates, including carotid intima-media thickness, coronary artery calcium, and abdominal aortic calcium, were obtained. During an average of 8 years of follow-up, 161 incident CHD events and 117 incident stroke events were documented. There was no significant association between ferritin levels and incident CHD events (p = 0.54 in men and p = 0.31 in women) and incident stroke (p = 0.17 in men and p = 0.56 in women), or both considered together (p = 0.70 in men and p = 0.69 in women). Ferritin was significantly correlated with abdominal aortic calcium (r = 0.09, p <0.01) in women but not in men. In conclusion, a higher serum ferritin level was not associated with an increased risk of incident CHD events or incident stroke, and may not be an independent predictor of incident CHD or stroke in blacks.