Pregabalin Does Not Increase Risk of Heart Failure Exacerbation in Patients With Pre-existing Heart Failure

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Background:

• Pregabalin's mechanism of action, involving calcium channel trafficking inhibition and sodium/water retention, suggests a potential risk for acute heart failure (AHF).
• Understanding this potential risk is crucial for managing patients with pre-existing heart failure (HF).

Purpose of the Study:

• To determine the prevalence of acute heart failure (HF) exacerbations in patients with pre-existing HF who were taking pregabalin compared to those who were not.
• To evaluate the composite outcome of emergency department (ED) visits, hospitalizations per-patient per-year (PPPY), and time-to-event for ED admissions and hospitalizations.

Main Methods:

• A retrospective cohort study utilizing propensity score matching to compare pregabalin users with pregabalin-naive patients with HF.
• Analysis included evaluating a composite of ED admissions or PPPY hospitalizations, and time-to-first ED admission or hospitalization within 365 days post-index.
• Doubly robust generalized linear regression and Cox-proportional hazard regression models were employed.

Main Results:

• A cohort of 385 pregabalin users and 3460 pregabalin nonusers with HF was matched.
• The estimated cumulative incidence of the primary outcome showed a hazard ratio of 1.099 (95% CI: 0.789-1.530; P = 0.58), indicating no statistically significant difference.
• Most patients in both groups received guideline-directed medical therapy for HF.

Conclusions:

• This large, single-center cohort study indicates that pregabalin is not associated with an increased risk of acute heart failure events in patients with pre-existing HF.
• The findings suggest that pregabalin can be used cautiously in HF patients without a significantly elevated risk of exacerbations.