The Impact of Cocaine Use and the Obesity Paradox in Patients with Heart Failure with Reduced Ejection Fraction due to Non-Ischemic Cardiomyopathy. Open Access

Abstract

Background: Obesity and illicit drugs are independent risk factors for developing heart failure. However, recent studies have suggested that patients who already have heart failure and are obese have better clinical outcomes; this has been called the obesity paradox. There currently exists a paucity of data on cocaine use and heart failure outcomes. Also, the effect of cocaine use on the obesity paradox has not been studied. Objectives: To assess the impact of cocaine use on the obesity paradox in patients with heart failure with a reduced ejection fraction (HFrEF) due to non-ischemic cardiomyopathy. Methods: In a single-centric, retrospective chart analysis, we reviewed all patients with ICD-10 codes for the diagnosis of HFrEF who were admitted at Metropolitan Hospital in New York City between 1/2013 and 12/2016. We studied the association between Body Mass Index (BMI) categories: non obese (<30 kg/m²) and obese (>30 kg/m²), cocaine use, and the primary outcome (30-days readmission). The interaction between cocaine use and obesity status, and its association with the primary outcome was also assessed. Results: 261 patients were identified; low BMI and cocaine use were associated with an increased hazard of readmission in 30-days for all subjects (HR: 2.28, 95% CI: 1.03 – 5.20; p=0.049 and HR: 3.12, 95% CI: 1.42 - 6.86; p=0.004, respectively). In addition, cocaine users who were non-obese were over 6 times more likely to be re-admitted in 30-days compared to non-cocaine users who were obese (HR: 6.45, 95% CI: 2.39 – 17.41; p=0.0002). Conclusions: Low BMI and continued use of cocaine have a negative additive effect in impacting heart failure outcomes.

Table of Contents

Introduction

Literature Review

           Definition and Classification of Heart Failure

           Epidemiology and Economic Burden

           Current Readmission and Reduction Initiatives

           Assessing Behavioral Risk Factors for Heart Failure

           Hypothesis

Methodology and Statistical Analysis

Results

Discussion

Implications and Recommendations

Study Limitations

Conclusions

Appendix of Tables and Figures

References

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health - MPH
Subfield / Discipline	Applied Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery
Keyword	Cocaine Obesity Paradox Heart Failure
Committee Chair / Thesis Advisor	Alonso, Alvaro, Emory University
Committee Members	Jones, Jeb, Emory University Ola, Olatunde, Mayo Clinic College of Medicine and Science

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