The Impact of Cocaine Use and the Obesity Paradox in Patients With Heart Failure With Reduced Ejection Fraction Due to Non-ischemic Cardiomyopathy.

• Authors: Alvaro Alonso, Emory University; AA Akinlonu, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, USA.; TO Mene-Afejuku, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, USA.; P Lopez, Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA.; T Kansara, Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA.; O Ola, Hospital Medicine, Mayo Clinic Health System, La Crosse, USA.; S Mushiyev, Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA.; G Pekler, Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA.
• Journal Title: Cureus
• Volume: Volume 15, Number 6
• Publisher: (publisher) | 2023-06, Pages e40298-e40298
• Type of Work: Article
• Publisher DOI: http://doi.org/10.7759/cureus.40298
• Keywords: cocaine use; heart failure outcomes; hospital readmission; non-ischemic cardiomyopathy; obesity paradox

Abstract

Background Obesity and illicit drugs are independent risk factors for developing heart failure (HF). However, recent studies have suggested that patients who already have HF and are obese have better clinical outcomes. We aim to study the effect of cocaine use on this obesity paradox phenomenon as it pertains to HF readmissions. Methodology In a retrospective chart analysis, we reviewed patients with a diagnosis of HF with reduced ejection fraction (HFrEF) admitted to Metropolitan Hospital in New York. We studied the association between body mass index (BMI) categories, namely, non-obese (<30 kg/m2) and obese (≥30 kg/m2), cocaine use, and the primary outcome (time to readmission for HF within 30 days after discharge). The interaction between cocaine and obesity status and its association with the primary outcome was also assessed. Results A total of 261 patients were identified. Non-obese status and cocaine use were associated with an increased hazard of readmission in 30 days (hazard ratio (HR) = 2.28, p = 0.049 and HR = 3.12, p = 0.004, respectively). Furthermore, cocaine users who were non-obese were over six times more likely to be re-admitted in 30 days compared to non-cocaine users who were obese (HR = 6.45, p = 0.0002). Conclusions Non-obese status and continued use of cocaine have a negative additive effect in impacting HF readmissions.