Category: Federal Forum Posters
Purpose: Cardiovascular disease is the leading cause of death in the United States and the number one cause of hospitalization within the Veterans Health Administration. Beta blockers are indicated for many cardiovascular conditions but are often avoided in veterans with documented history of cocaine use due to theorized harmful effects resulting from unopposed alpha stimulation. This project will examine the clinical significance of unopposed alpha stimulation secondary to beta blocker therapy in veterans who use cocaine to evaluate the best practice for these patients.
Methods: This retrospective cohort analysis will include patients from the Lexington VA Health Care System with a urine drug screen positive for cocaine from 2000-2012. The study will examine the clinical significance of unopposed alpha stimulation by comparing cardiovascular outcomes between patients who were prescribed and compliant with an outpatient beta blocker for a total of five years and patients who were not prescribed an outpatient beta blocker. The primary objective of this is study is a composite endpoint which will include acute coronary syndromes, stroke, hypertensive emergency or urgency, congestive heart failure, and atrial or ventricular arrhythmia. Secondary objectives will determine if there is a significant difference between groups in each individual component of the primary objective described above as well as all-cause mortality and cardiovascular mortality. A subgroup analysis will be performed to examine if a difference in cardiovascular outcomes is present based on the differing adrenergic receptor activity between beta blockers. Relative risk and 95% confidence intervals will be calculated to compare probabilities of the composite endpoint between the two groups. Chi-square and students t-test will be used to calculate differences in baseline characteristics. For all objectives, α of <0.05 will be considered significant.
Whitley Whitehead– PGY1 Pharmacy Resident, Lexington VA Health Care System, Lexington, KY