Use of pregabalin may increase risk of heart failure in geriatric patients

1. In patients aged 65 to 89 years of age with non-cancer chronic pain, use of pregabalin was associated with an increased risk of developing heart failure (HF) compared with gabapentin. 

Evidence Rating Level: 2 (Good)

Pregabalin and gabapentin are commonly prescribed medications for the management of chronic pain. While both medications may be associated with cardiovascular adverse effects based on limited reports, existing studies have limited their analyses to neurological indications or have not focused on older adults. This retrospective cohort study therefore sought to investigate the incidence of HF in older adults using pregabalin compared with gabapentin. 246,237 patients (median age[IQR], 73[69-78] years; 66.8% female) aged 65 to 89 years of age receiving pregabalin or gabapentin for chronic pain without a history of HF from the United States were included in this study. The primary endpoint was hospitalization or ED visit with a diagnosis of HF, with secondary endpoints including a diagnosis of HF in the outpatient setting. The incidence of HF with pregabalin was 18.2 (95% CI, 15.3-21.6) per 1000 person-years compared to 12.5 (95% CI, 11.9-13.2) per 1000 person-years for gabapentin, with a corresponding adjusted hazard ratio (AHR) for pregabalin vs gabapentin of 1.48 (95% CI, 1.19-1.77). Additionally, there was a higher incidence of outpatient diagnosis of HF in patients receiving pregabalin compared to gabapentin (AHR, 1.27 [95% CI, 1.02-1.58]). Overall, this study found that among older patients with non-cancer chronic pain, management with pregabalin was associated with higher risk of HF compared with gabapentin. 

Click to read the study in JAMA Network Open

Image: PD

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